Permit t a= CITY OF TIGARD ELECTRICAL PERMIT
.y PERMIT #: ELC2002 -00533
II DEVELOPMENT SERVICES DATE ISSUED: 10/11/02
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S113AA -00500
SITE ADDRESS: 16100 SW 72ND AVE B -18
SUBDIVISION: ZONING. I -L
BLOCK: LOT : OOA JURISDICTION: TIG
Project Description: Installation of (5) branch circuits for workstations. Job No. 43690S
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: 4 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 STONER ELECTRIC
15350 SW SEQUOIA PKWY #300 -WMI 1904 SE OCHOCO STREET
PORTLAND, OR 97224 MILWAUKIE, OR 97222
Phone: Phone: 503 - 462 -6500
Reg #: ELE 26 - 122C
FEES
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 10/11/02 $73.45
[TAX] 8% State Tax 10/11/02 $5 Rough -
Elect'I Final
Total $79.32
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- 324
Issued By: 4 � - Permit Signature: 671/ / 9-7 0 /G. z ef
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:
Call 639 -4175 by 7:OOpm for an inspection the next business day
10/07/2002 MON 14:31 FAX 5036592824 STONER SERVICE Cj 002
Electrica P ermit Application
Date received: /9/7/0 Z Permit no. :Ez j ;''�i'I
F City of Tigard - �.,_ - c Z- aos33
f�� ProJetK/appl.no.: Expire date:
City of Tigard Address: 13125 SW Halt BlvdI't t
Phone: (503) 639 -4171 issued: BY Receipt no.:
Fax: (503) 598 -1960 0 CT - 7 Z Q 01 Case file no Payment type:
Land use approval: CII Y Of ItAiT ,W
MTTTF lrt•J ? nTr't,a'z1 7rrekT
1T'I'E OF PERMIT
0 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi - family Tenant improvement
0 New construction 0 Addition/alteration/replacement 0 Other. 0 Partial
JOB SITE INFORMATION
Job address: / „lot) bo) zaf a 40 Bldg. no.: Suite no.: Tax map/tax lot/account no.:
Lot: I Block: 'Subdivision:
Project name: 1 , , i , _ Description and location of work on premises: , / ' ` r
Estimated date of '. pletion/inspection: / 4
C O N „ _ :... ._ .:_... ... FEE SCHEMI E.._
.. _..__ —_ . - __ __:._
lob no: 3 b 4 o s Fee Max
Business name: Sip j •t.lel CT1Gc- Description Qty. (ea.) Total no. hop
Addmss: 1 SE taef►aco - New restdendsd -sinker muld-fanllYper
City: Al «DA•tarGL I State:O ZIP:9-fa - � a
Pho nel41- 4111.24. Sa I Faxt. 4T 16-mail: 1000 sq. ft. or less 4
z / I.. e
Each additional 500 sq. ft. or portion thereof
CCB no.: 4. 4e 1 Elec. bus. lie. no:
City/metro 'c. no.: �8f J(� Limited rgy, residential ■ 2
/.� � 7 � D energy. non-residential 2
��
/ Each manufactured home e or or modular dwelling
Signature of supervising electrician (required) Date Service and/or feeder
2
Snp elect. name (print): ,if i eee/ I cetro:a4945. Sertilasorfeeders- I�IWion,
PROI'ERTA'
alteration or
200 amps or leas 2
Name (print): 201 maps to 400 amps 2
Mailing address: — 401 amps to 600 stops 2
City: I State: (Z1P: 601 amps to 1000 amps 2
Over 1000 amps or volts 2,
Phone: I Fax: E-mail: Recvnnectonly _ 1
Owner installation: The installation is being made on property I own Thy sew or feeders -
which is not intended for sale, lease, rent, or exchange according to Installation, vtaad?4ortcloa@om
ORS 447, 455, 479, 670, 701. 200a” or less 2
Owner's signature: Date: , 201 amps to 400 amps 2
401 to 600 amps 2
ENC INFER Branch circuits- new, alteration,
Name: or extension per panel:
A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit p ,
o 2
Phone: Fax' State: ZIP: _ B. Fee for branch circuits r tout purchase I 4 ,
94,E of service or feeder u f first brarrclt circirc ' Ay 9 ' uit: .
Each additional branch circuit: O
• PLAN ItE%'II:11' (Please check all that apply) Misc. (Service or feeder not included):
O -0
Service over 22S ampsommeteial 0 Heatth-cate.facility Each pump or irrigation circle 2
O Service over 320 amps - rating of 18x2 O Hazardous location Each signor outline lighting 2
family dwellings 0 Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel.
0 System over 600 volts nominal mote residential units in one structure alteration, or extension* 2
0 Building over three stories 0 Feeders. 400 amps or more *Description:
O Occupant load over 99 persons 0 Manufactured structures or RV park Each additional Inspection over the allowable In any of the above
0 Egressilightingplan 0 Other:
Per inspection 1 l l l
Submit sets of plans with any oldie above. investigation fee
The above are not applicable to temporary construction twice. Other
I.
' Not a0 kaisdaloor moat coedit d,, please can jurisdiction for more information. Notice: This permit application Permit fee $ 1 N 79,95
O Visa 0 MasterCard expires if a permit is not obtained Plan review (at _ %) $
aeau card mother: / / within 180 days after it has been State surcharge (8%) .... $ .11 Sr f'
Noma et cardholder as shown ao credit card
Expires accepted as complete. TOTAL $ . 3
S
140x615 t?9
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
l v /�� BUP
Received Date Requested / AM PM BUP
Location 7 /4 7 c- ` Suite MEC
Contact Person a
...ow-4 ) PLM
Contractor �' r ' • ( ) 4 16 (-"Sa
BUILDING Tenant/Ownee 0 / i A--c d ELC � r 53 3
-
Footing
Foundation ELC
Ftg Drain Access: ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Drywall Nailing
Drywall N v J c
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling •
Roof Other: _ i-
Final i to II a •
//
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
UG/Slab
Low Voltage
C arm
F � Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
f AS PART FAIL
Please call for reinspection RE: El Unable to inspect — no access
Fire Supply Line
ADA
D /0/ff-�2 I nspe c t o r • �ti.. Ext
Approach/Sidewalk —
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL