Permit 1-4 CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2006 -00222
, ,.� i DEVELOPMENT SERVICES DATE ISSUED: 4/26/2006
I
13125 SW Hall Blvd., Tigard, OR 97223 503 639 - 4171 PARCEL: 2S112DC - 00701
SITE ADDRESS: 15989 SW 72ND AVE BLDG -A ZONING: I -P
SUBDIVISION: OREGON BUSINESS PARK III LOT : 038 JURISDICTION: TIG
Project Description: (9) branch circuits.
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: 8 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 TIMBERLINE ELECTRICAL CONTRACTORS
15350 SW SEQUOIA PKWY #300 -WMI PO BOX 298
PORTLAND, OR 97224 LAKE OSWEGO, OR 97034
Phone: Contact #: PRI 503 - 969 -8488
FAX 503 - 254 -4227
FEES
Description Date Amount Reg #: ELE 26 -121 IC
[ELPRMT] ELC Permit 4/26/2006 $100.05 LIC 160037
[TAX] 8% State Surcharge 4/26/2006 $8.00 SUP 4957S
Total $108.05 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 question to OUNC at 503 - 246 -6699 or
1- 800 - 332 -2344.
Issued By: Permittee Signature: �� -
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, tease, 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 Ap .1' \' D FOR OFFICE USE ONLY
R �� - A i I • � ' ) 2
City of Tigard Da : i , . p PemritNo.: ( fit! ./ J
13125 SW Hall Blvd., Tigard, OR 97223 , 1., 1 1(1% Plan Review Other Permit:
Phone: 503.639.4171 Fax: 503.598.1960 4. ' l l ' �' Date/By:
Line: 503.639.4175 e• il Date Ready/By: 1uris: El See Page 2 for
Internet: w GO
"V V o TIGP+� ' - -- Notified/Method: Supplemental Information
+ �bO R IC►ah►
e., construction Addition /alteration/replacement Please check all that apply:
llT���"`
['Service over 225 amps, comm'l ['Hazardous location
❑ Demolition ❑ Other: _ ['Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
- - :;CA OF CONSTRUCTION • - - • of 1- and 2- family dwellings 4 or more new residential
❑ 1- and 2- family dwelling XCommercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
['Building over three stories ['Feeders, 400 amps or rnore
❑ Multi- family 0 Master builder ❑Other: ❑Occupant load over 99 persons ❑Manufactured structures or
JOB S1PE INFORMATION. �ANT1 LOCATION -, ❑ RV park
p
Egress/lighting plan
. - - no r ❑Health -care facility ❑Other:
Job no.: Job site address: J 5?87 Ali) ? � 14(� p Submit 2 sets of plans with any of the above.
City/ State/ZIP: T( ,D vR The above are not applicable to temporary construction service.
';, =FEE! •SCEEDULE. •.
Suite/bldg. /apt. no.: Project name: 0 0 M l KO S am. 11
Description I Qty. I Fee. Total 1 "
Cross street/directions to job site: New residential single- or multi - family dwelling unit.
Includes attached garage.
1,000 sq. ft. or Tess 145.15 4
Subdivision: Lot no.: Ea- add'l 500 sq. ft. or portion 33.40
Limited energy, residential 75.00 2
Tax map /party l no.: Limited energy, non - residential 75.00 2
DESCRIPTION "OF.FVQRK' Each manufactured or modular
dwelling, service and/or feeder 90.90 2
g Nn O 0 — S 1(;20 Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
201 amps to 400 amps 106.85 2
El. PROPERTY .OWNER I . - TENANT: 401 amps to 600 arnps 160.60 2
Name: 601 amps to 1,000 amps 240.60 2
Address: 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 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 600 amps 133.75 - 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel • MI :APPLICA : :0i ' CONTACT PERSON ; . . • A. Fee for branch circuits with
. . • service or feeder fee, each 6.65 2
Business name: branch circuit
B. Fee for branch circuits ppLL
Contact name: p.p5 without service or feeder fee, I 46.85 2
each branch circuit Q
Address: Each add'! branch circuit 8 6.65 53.20 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
extension. Describe: Page 2 2
Business name: T 4"— Reap.,f Cpv��RAti'DQ.
I-11 0 �w 1�, Each additional inspection over allowable in any of the above
Address:
`'` Per inspection 62.50
City/State/ZIP: Pp' `t.../i^fZ, , b t2 C( 7239 Investigation per hour (1 hr min) 62.50
Phone: (50,3 A i 59 - 4 o6 1 Fax: ( 6 63) 25 i,4_ 4 Z Z - 7 Industrial plant per hour ‚ 3 7 5 -
[ ( 9 3 1
• * Electrical Lic.: - Z i 1 Suprv. Lic.: y q5 - 7 Subtotal /00.03
Suprv. Electrician signature, required: Plan review (25% of permit fee)
- State surcharge (8% of permit fee) S , b O
Print name: a , [ I 3- • 4 ! ( ! (t Da te: y. Ak . 0 b
TOTAL PERMIT FEE 10 8.05
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.
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2006.00222
13125 SW Hall Blvd., Tigard, OR 97223 — DATE ISSUED: 4/26/2006
Phone: (503) 639 -4171 11 ri 11 0 1
Inspection Requests (24 Hrs.): (503) 639 -4175 .���$. , __1,
INSPECTION WORKSHEET FOR DATE: 6/7/2006 TIME: 7 :O6AM PAGE: 71
SITE ADDRESS: 15939 SW 72ND AVE BLDG - A CLASS OF WORK:
SUBDIVISION: OREGON BUSINESS PARK III LOT #: 038 TYPE OF USE:
PROJECT NAME: DOMINOS
DESCRIPTION: (9) branch circuits.
OWNER: PACIFIC REALTY ASSOCIATES, PHONE #:
CONTRACTOR: TIMBERLINE ELECTRICAL CONTRACTORS PHONE #: 503.969 - 8406
Inspection Request Scheduled For: Date: 6/7 /2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
125 Wall cover 031257 -01 503 - 820.1526 N
110 c--8-1 LA A N CA N c'2
Corrections /Comments nstructions:
0 V l.:0 LZ1M-AL s i C V 2 t 0 PE%WU.
�v No cxtla Q�S w r `m�ot' T cg-a..b
No V.40
ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: G -.‘4 L6 Date: 6' ' C]O Phone #: (503) 718 7,0
CITY OF TIGARD
BUILDING DIVISION • PERMIT #: ELC200G- 00 ?_d2
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/2642006 —
Phone: (503) 639 -41711
Inspection Requests (24 Hrs.): (503) 639 -4175 &- III
INSPECTION WORKSHEET FOR DATE: 8/25/2006 TIME: 7 :16AM PAGE: 24
SITE ADDRESS: 16989 SW 72ND AVE BLDG -A CLASS OF WORK:
SUBDIVISION: OREGON BUSINESS PARK 111 LOT #: 038 TYPE OF USE:
PROJECT NAME: DOMINOS
DESCRIPTION: (9) branch circuits.
OWNER: PACIFIC REALTY ASSOCIATES, PHONE #:
CONTRACTOR: TIMBERLINE ELECTRICAL CONTRACTORS PHONE #: 503.969•8408
Inspection Request Scheduled For: Date: 8/2512006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical Final 035570 -01 503- 820 -1526 N
Corrections /Comments /Instructions: *6--C A \
-4g vck.c•Nri p sr P (A Nl W.A.. 9 6 4 1- 103
❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
A FAIL ,CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: W 0 12 Date: 0 1p Phone #: (503) 718- 1..06
CITY OF TIGARD _
BUILDING DIVISION PERMIT #: ELC2006 -00222
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 4/26/2006
Phone: (503) 639 -4171 A iy il
Inspection Requests (24 Hrs.): (503) 639 -4175 J ^:
INSPECTION WORKSHEET FOR DATE: 10/24/2006 TIME: 7:02AM PAGE: 66
SITE ADDRESS: 15989 SW 72ND AVE BLDG - CLASS OF WORK:
SUBDIVISION: OREGON BUSINESS PARK III LOT #: 038 TYPE OF USE:
PROJECT NAME: DOMINOS
DESCRIPTION: (9) branch circuits.
OWNER: PACIFIC REALTY ASSOCIATES, PHONE #:
CONTRACTOR: TIMBERLINE ELECTRICAL CONTRACTORS tJ ( w\) PHONE #: 503 - 969-8488
Inspection Request Scheduled For: Date: 10/24/2006 Pour Time:
Code # • • -ction Description Confirm # Contact # Message
199 Electrical Tina 038700 -01 503 - 313-0331 Y
-- -- _ : - - - - - - - •c ions:
N.
- V
,
''ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: GY' , V 66 Ur Date: 10 I Vi('* Phone #: (503) 718- .1,14
CITY OF TIGARD PERMIT #:
BUILDING DIVISION DATE ISSUED:
13125 SW Hall Blvd., Tigard, OR 97223
Phone: (503) 639 -4171 " ,,„1 , 0:,i i:,,''
Inspection Requests (24 Hrs.): (503) 639 -4175 ` ----
INSPECTION WORKSHEET FOR DAT *al mil TI om j_ ,..i,/i J PAGE:
o '. 1 ?phi sMN!. SITE ADDRESS: 1 5q D6 3 c S to ?phi CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION: Aviv_
OWNER: ()Mil h!) / 5 PHONE #: 5 33a)
CONTRACTOR: �r Cl 11 9 PHONE #: 6D ,, Sw,..aCi
Inspection Request Scheduled For: Date: Pour Time:
Code # Inspection Description Confirm # Contact # Message
Corrections /Comments /Instructions: ' /V�j CL ,�
PASS ) ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
!L /// ❑ CALL FOR REINSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: G- . N Oe, Lc. Date: 1 a ekolp Phone #: (503) 718- 24
i:\Building\IVR\IVR-InspWorlcsheet-BlankFonn.doc 03/02/2005