Permit CITY. OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00289
DEVELOPMENT SERVICES DATE ISSUED: 5/24/2004
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 - 4171
PARCEL: 2 S 113A D -01800
SITE, 16650 SW 72ND AVE B -12
SUBDIVISION: OREGON BUSINESS PARK 1 ZONING: I -L
BLOCK: LOT : 011 JURISDICTION: TIG
Project Description: Install 10 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: R 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: —9 / ( 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 BRIDGETOWN ELECTRIC
15350 SW SEQUOIA PKWY #300 -WMI 22732 NW GILLIHAN ROAD
PORTLAND, OR 97224 PORTLAND, OR 97231
Phone: Phone: 503 - 621 - 7122
Reg #: LIC 103824
SUP 4177S
FEES ELE 26-887C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 5/24/2004 $106.70
[TAX] 8% State Surcharge 5/24/2004 $8.54 Rough -
Elect'I Final
Total $115.24
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- -23 .
Issued By: Z./c.f.-tee/1- Permit Signature: 09'i £O2""
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
. .
' „--
, , Electrical PermitA►pplication
l7atcreceiv , , - o Permit no jl Oa !
,.,1,1':'• Ci of and RECEIVE 1' Project/appL , o.: Expire date:
City of ligard Address: 13125 SW Hall Blvd. Tigard, OR 97223 Date issued:
Phone: (503) 6394171 s Receipt no.:
MAY
Fax: (503) 598 -1960 2U04 Case file no.: Payment type:
Land use approval: CITY OF TIGARD
:. _...LAI.te . _._ ....
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory Commerciallndtrstria 0 Multi - family 0 Tenant improvement
O New construction 0 Addition /alteration/replacement 0 Other. 0 Partial
JOB SITE INFORMATION
Job address: I (p (O S 0 S v..) .1 p_tt Bldg. no.: Suite no.: Tax map/tax lot/account no.:
Lot: JBlocic: JSubdivision:
Project name: Ey rt.(. )i1,t4 I Description and location of work on premises: 191 'e. - Pis�[Sdp_.[
Estimated date of con letion /inspection:
CONTRACTOR APPLICATION — FEE SCIIEDILE
Job no: elf- Fee mart
Business name i di F f GtG n [_1.e a - - tVewresideffial- Qty. (ea.) Total no. imp
A.?- 3 .1.- w G(' 1 t r P-4 d„ t „& •
City: . P0 r11-4 h l state: oqZIP 4 17 2,3/ Senloeiodudek
Phone: 2-1 'J / 2. i I Fax:(ez/ - 7f 23 I E -mail: btC a WeildDkf. 1000 sq. R or lcss 4
-
Each additional 500 sq. It or portion thereof
GCB no.: 1 p.3 S '24 I Elec. bus. lie- no: 7 c Limited energy, residential 2
City/ -tto Iic. no.: 3 (4-b Limited energy. non- residential 2
�.e._y .1- .5 - C ` -. Each manufactured home or modular dwelling
Si r - . . .. - : electrician (required) Date Service and/or feeder 2
Sup.eled. name (print): Kee ttli Sk -ensL 4) License no: 4 (T 15 Scrrboesorfeeders— lnsteuation,
PROPERTY OWNER 20 rl eatla
2000 amps a orless txs 2
Name (print): 201 amps to 400 amps 2
Mailing address: 601 1
a to 00 amps 2
amps to 1000 amps 2
City: ( State: 'Ea _ Over 1000 amps or volts . 2
Phone: I Fax: I E -mail: Reoonnectoaly 1
Owner installation: The installation is being made on property 1 own Temporary services orfeede's-
which is not intended for sale, lease, rent, or exchange according to ermi
ORS 447, 455, 479, 670, 701. 201 amps or less 2
201 amps to 400 amps 2
Owner's signaaue: _ Date: 40110 600: • • 2
ENGINEER Brvndien' nits - new, &Herndon, panel .
Name: or extension on P
A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
City: State: ZIP: _ 11 Fee for branch circuits without p '4
of service or feeder fee, firstbranch Ai circuit / L.YS 2
Phone: Fax: E-mail:
Each Mt:Miami branch circuit: / !... .0 Si, s
PLAN REVIEW (Please check all that appl)) Misr (Senieeor feeder not lachrded):
O Service over 225 ampseorm ereia1 O Flealth•carefacility Each pump or irrigation circle 2
0 Service over 320 amps - rating of 18t2 0 Haun ddus location Each signor outline lighting 2
Lundy dwellings O Building over 10,000 square feet fgnr or Signal circait(s) or a limited energy Panel.
0 System over 600 volts nominal snort residential units inonestroctu a alteration orextendon• 2
0 Bui1i ng over*1u a stories 0 Feeders, 400 amps or more aDeseription-
O Oaaepant load over 99 persons 0 Manufactured structures or RV park Eadt addilional impedion over the allowable la coy of the above:
O EStessnightindPian O Other Pea inspection 1 1 1 1
Sabmit tads of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other
e N1or as jmisektioas a comfit pt a eardr. please nn jurisdiction far et
me information.' Notice: This permit application
Permit fee $ i ay- 74
litnsa 0 MasterCard expires if a permit is not obtained' Plan review (at _ %) $
cwt card 1 + O% / (F / Ors within 180 days after it has been State surcharge (8%) .... $ • `t
le in b 4-a d Expires accepted as complete. TOTAL $ /1 S • 7-7
)6' $// S
etiadnam« algnrtare amo®h , 440.4615 (64.002'OM)
1'd E21G -129 -00S pijsuaa •4g qt a>I dOO :20 b0 1Z ReW
CITY OF TIGARD 24 -Hour ;
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION' • Business Line: (503) 639 -4171 MST
BUP
Received //ll
c" SU Date Requested '�S AM PM BUP
Location 7,3 Suite MEC
Contact Person �� Ph ( ) lD PLM
Contractor Ph ( )- SWR
BUILDING Tenant/Owner � ELC
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
Firewall Q,,�-0 Rt,q F ' / AI
Fire Sprinkler / ,1
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
Fire Alarm
PART FAIL
❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
El Please call for reinspection RE: 1=1 Unable to inspect — no access
Fire Supply Line
ADA /� - - f4, tJ
Approach/Sidewalk Date 7- V v I nspector cam/ izo ( Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL