Permit • CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00538
tai DEVELOPMENT SERVICES DATE ISSUED: 8/25/2004
�1'�I �! 13125 SW Hall Blvd., Tigard. OR 97223 (503) 639 - 4171
PARCEL: 2 S 113AA -00400
SITE ADDRESS: 16240 SW 72ND AVE B -02
SUBDIVISION: OREGON BUSINESS PARK I ZONING. I -L
BLOCK: LOT : 018 JURISDICTION: TIG
Project Description: 1 100amp add.
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: SIGNAUPANEL:
MANF HM/ SVC/ FDR: 601 +amps -1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: 1 W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 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:
PACIFIC REALTY ASSOCIATES GREENWAY ELECTRIC COMPANY
15350 SW SEQUOIA PKWY #300 -WMI 9460 SW TIGARD STE. 104
PORTLAND, OR 97224 TIGARD, OR 97223
Phone: Phone: 503 - 620 -6020
Reg #: LIC 153421
ELE 34 -617C
FEES sup 50255
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 8/25/2004 $80.30
[TAX] 8% State Surcharge 8/25/2004 $6.42 Elect'I Service
Rough -in
Total $86.72 Elect'l 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 tkestions to OUNC at (503)
246 -0699 or 1 -800- 332 -2344.
Issued By: ,,.1 Permit Signature:,
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
- - . RECEIVED
Electrical Permit Applicata& 2 5 LU FOR OFFICE: lJS1i: ()NIA
•
City of Ti CITY OF TIGA • Dat Permit No.: e e/B : `� a 6 -DZ '
13125 SW Hall Blvd., Tigard, OR 97223 ^ Plan Revi
Phone: 503.639.4171 Fax: 503.598.1960 BUILDING DIV :140 �-.4 `
Date/B Other Permit:
Inspection Linc: 503.639.4175 I � l , Date Ready/By: Juris: ® See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction ® Addition/alteration/replacement Please check all that apply:
❑ Demolition ❑Other: ❑Scrvice over 225 amps, comm'I ❑Hazardous location
['Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential
❑ 1 and 2 family dwelling ® Commercial /industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
['Building over three stories ['Feeders, 400 amps or more
❑ Multi - family 0 Master builder 0 Other:
['Occupant load over 99 persons ['Manufactured structures or
JOB SITE INFORMATION AND LOCATION ['Egress/lighting plan RV park
❑Health -care facility ['Other
Job no.: 30495-2 Job site address: 16240 SW 72nd Avenue Submit 2 sets of plans with any of the above.
City/State /ZIP: Portland, OR 97224 The above arc not applicable to temporary construction scrvicc.
Suite/bldg. /apt. no.: Project name: Production Tool - Add 100A Feed FEE* SCHEDULE
Description I Qiy. I Fee. I Total I "
Cross street/directions to job site: New residential single- or multi - family dwelling unit.
Includes attached garage. _
1,000 sq. ft. or less 145.15 0.00 4
Subdivision: Lot no.: Ea. add'I 500 sq. ft. or portion 33.40 0.00 I
Limited cncrgy, residential 75.00 0.00 2
Tax map /parcel no.: Limited cncrgy, non - residential 75.00 0.00 2
DESCRIPTION OF WORK Each manufactured or modular
Add 100A Feeder dwelling, scrvicc and/or feeder 90.90 0.00 - 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 1 80.30 80.30 2
al PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 0.00 2
401 amps to 600 amps 160.60 0.00 _ 2
Name: Production Tool 601 amps to 1,000 amps 240.60 0.00 2
Address: 16240 SW 72nd Avenue Over 1,000 amps or volts 454.65 0.00 2
Reconnect only 66.85 0.00 2
City/State /ZIP: Portland, OR 97224 Temporary services or feeders installation, alteration, and/or
5 03 - 598 -0393 5 03 - 59 -0364
Phone: Fax: relocation 200 amps or less 66.85 0.00
Owner installation: This installation is being made on property that 1 own which is not 201 amps to 400 amps 100.30 0.00 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 0.00 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
❑ APPLICANT 1 ❑ CONTACT PERSON A. Fee for branch circuits with
scrvicc or feeder fee, each 6.65 2
Business name: branch circuit 0.00
B. Fcc for branch circuits
Contact name: without scrvicc or feeder fcc,
each branch circuit 46.85 0.00 2
Address:
Each add'I branch circuit 6.65 0.00 2
City/State /ZIP: Miscellaneous (service or feeder not included)
Pump or irrigation circle I 53.40 10.00 I 2
Phone:( ) Fax::( )
Sign or outline lighting 53.40 0,00 2
E - mail: Signal circuit(s) or limitcd-
CONTRACTOR cncrgy panel, alteration, or
extension. Describe: Page 2 2
Business name: Greenway Electric Company 0.00
Address: 9460 SW Tigard St., Ste. 104 Each additional inspection over allowable in any of the above
Pcr inspection 62.50 0.00
City/State /ZIP: Tigard, Oregon 97223 Investigation per hour (I hr min) 62.50 0.00
Phone: (503) 620 -6020 Fax: i (503) 620 -6124 Industrial plant per hour 73.75 0.00
ELECTRICAL PERMIT FEES*
CCB Lic.: 153421 Electrical Lic.: 34 - 617C Suprv. Lic.: 5025S Subtotal $80.30
Suprv. Electrician signature, required: ( / / Plan review (25% of permit fcc)
State surcharge (8 % of permit fcc) $6.42
Print name: James V. Ro ney t 08/25/2004
`� TOTAL PERMIT FEE $86.72
Authorized signature:
Ali / /; . � This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: Mark Short Da 0 8/25/2004 • Fee methodology set by Tri-County Building Industry Service Board
•• Number of inspections per permit allowed.
i:\ Building \Permits \ELC.PermitApp.doc 12/03 440 -4615T(10 /02 /COM/WEB
• '
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
i:\B ilding\Pertnits\ELC- PcnitApp.doc 04!03
CITY OF TIGARD 24 -Hour
BUILDING Inspection,; Line: (503) 639 -4175
INSPECTION DIVISION Business Linea (503) 639 -4171 MST
BUP
Received j // 7`` Date Requested - a' 7 AM PM BUP
/
Location I' 0 Suite MEC
Contact Person Ph (_ ) Z 0 - (o D 2- PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner P ' - -�QJ r i ce , — ELC L{- co ,S 3
Footing ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam Salk
Shear Anchors INN
Sheath/Shear
Int Sheath/Shear NOV
Framing
Insulation DO M h. � !/1 /, _7 k 9PA �"1 / 66 y „
Drywall Nailing �iC—
Fire wall
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
UG/Slab
Low Voltage
Fir= larm
_• Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
404, PART FAIL
Please call for reinspection RE: Unable to inspect — no access
Fire ADASupply Line D
ate
_ O Ins ector [6/1,1_ n y Ext a e p
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL