Permit CITY O 1 TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2003- 00567
DEVELOPMENT SERVICES DATE ISSUED: 9/10/03
F "`' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S112DC -01500
SITE ADDRESS: 15757 SW 74TH AVE BLD D
SUBDIVISION: FANNO CREEK ACRE TRACTS ZONING: I -P
BLOCK: LOT : 006 JURISDICTION: TIG
Project Description: Install (2) 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: I 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:
74TH AVENUE INDUSTRIAL PARK LL GENIE ELECTRIC CONSTRUCTION
8100 SW DURHAM RD 8701 SE 156TH AVENUE
TIGARD, OR 97224 PORTLAND, OR 97236
Phone: Phone: 503 - 762 -9296
Reg #: LJC 56639
SUP 4536S
FEES ELE 34 -488C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 9/10/03 $53.50
[TAX] 8% State Tax 9/10/03 $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 - 332 -2344.
Issued By ' ` / Permit Si natu '
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 Permit Application Received C//Q � ONL • - Date/By: b Permit No.��&3 e 7J7
City of Tigard RECEIVED PlannAppr al Sign
Date/By: Sign
No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 SEP 1 0 2003 Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: 503-598- 960 i Post-Review Land Use .
Internet: www.ci.tigard.or.us �;
/ /�innri � i ? Date/By: Case No.:
C'TXO F A . A Ll► . Contact Jyris.: Su See Page 2 for
24 -hour Inspection Request: c L / Name/Method: (7e - Supplemental Information.
VISIO
.. TT
Ms.,�,����,��TI�. ��0�!'0�` s�� � a�_ _ ���� ,.�.I�W� il e citeel��all�t, aka y)WiS-W ZM
❑ construction 111 Demolition ❑ Service over 225 amps- ❑ Health -care facility
Addition/alteration/replacement ❑ Other: commercial ❑ Hazardous location
❑ Service over 320 amps -rating of 0 Building over 10,000 square feet,
i. e.,�_ C TI C O 2Y OE � C® �S , FJ�O p r ,,,, ', , 1 & 2 family dwellings four or more residential units in
❑ 1 & 2- Family dwelling 11/Commercial/Industrial ❑ System over 600 volts nominal one structure
❑ Building over three stories ❑ Feeders, 400 amps or more
❑ Accessory Building ❑ Multi- Family ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other:
I IPSE 'O ZM" T €iOg fan iteit` 'T' C1g " ` `;` Submit _ sets of plans with any of the above.
r, �<., _, `S �_ .... ITw `- _.. ,.._ � The above are not applicable to temporary construction service.
Job site address: /57 VU) -77 / _ _- te ° .. *t MS 11 . ..AIR
Suite #: Bldg./Apt.#: Number of inspections per permit allowed
Project Name: 747`Z 4 ' $/fi4i- Dot `9 Description Qty Fee (ea.) Total i
Ob site: New residential- single or multi- family per
Cross street/Directions to
j. dwelling unit. Includes attached garage.
Kv((// /�� / � aii / 7/( / , Service included:
1000 sq. ft. or less 145.15 4
Each additional 500 sq. ft or portion thereof 33.40 1
Subdivision: Lot #: Limited energy, residential 75.00 2
Limited energy, non residential 75.00 2
Tax map /parcel #: Each manufactured home or modular dwelling
#tivarf a D mRI TTO ),Oo WA ° mamma servi and/or feeder 90.90 2
S ervices or feeders - installation,
alteration or relocation:
200 amps or less 80.30 2
201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
LI :0131 RMUWL IER „ „ `N IE1 OESI N+ A 601 amps to 1000 amps 240.60 2
Name: 9 till Ca s Ad e -
Over
eco nett amps or volts 454.65 2
Reconnect only 66.85 2
Address: 4f /00 G u) Vci7ird of a/ Temporary services or feeders - installation,
,Q_ lr /� alteration, or relocation:
City /State /Zip: - Tr r A d C/ //�� 200 amps or less 66.85 1
Phone 403 — 3.9-/.3 95 Fax:5Q � 2 / -cr2 "�(/. 201 amps to 400 amps 100.30 2
401 to 600 amps 133.75 2
PL' C T IM N. - ' CO TT GT413 RSO_, 3 p
Branch circuits -new, alteration, or
Name: a 6o? extension per panel:
Address: A Fee for branch circuits with purchase of
service or feeder fee, each branch circuit 6.65 2
City /State /Zip: B. Fee for branch circuits without purchase of
service or feeder fee, first branch circuit / 46.85 2
Phone: Fax: Each additional branch circuit / 6.65 2
E -mail: Misc.(Service or feeder not included):
r x a s Each pump or irrigation circle 53.40 2
Each sign or outline lighting 53.40 2
Job No: Signal circuit(s) or a limited energy panel,
Business Name: 6--C e/6" , TJ"c — G Description:
or extension Page 2 2
Description:
Address: 70/ se- Ls 6,W%. ,/
ClCity/ State/Zip: Each additional inspection over the allowable in any of the above:
t 1 MI/ Per inspection per hour (min. 1 hour) 62.50
Phone: ,S - 76; Fax: Investigation fee:
Other
CCB Lic. #: 1 _ &D 3 Lic. #:' — ar° ,� .. EICC Tic etmit ECM s ? T '
Supervising electrician Subtotal $ 5 ?). so
signature required: - Plan Review (25% of Permit Fee) $
Print Name: Lic. #: ,./ 5' State Surcharge (8% of Permit Fee) $ a
TOTAL PERMIT FEE $ S 7- 7 g
Authorize ;� / / /r7 / a3 Notice: This permit application expires if a permit is not obtained within
Signature Date: 180 das er has bcepted co mplete.
•
Q s Ale
/ *Fee m y set.by een Tri ac -County as Bu ilding Industry Service Board.
\faa1� S � G
(Please print name)
i:\Dsts\Permit Forms \ElcPermitApp.doc 01/03
•
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES: •
RESIDENTIAL WORK ONLY:
Fee for all systems $75.00
Check Type of Work Involved:
• n Audio and Stereo Systems
n Burglar Alarm
Garage Door Opener
Heating, Ventilation and Air Conditioning System
n Vacuum Systems
n Other
COMMERCIAL WORK ONLY:
Fee for each system $75.00
(SEE OAR 918 - 260 -260)
Check Type of Work Involved:
n Audio and Stereo Systems
n Boiler Controls
IT Clock Systems
n Data Telecommunication Installation
El Fire Alarm Installation
n HVAC
n Instrumentation
Ti Intercom and Paging Systems
1 Landscape Irrigation Control
n Medical
n Nurse Calls
n Outdoor Landscape Lighting
n Protective Signaling
n Other
Number of Systems
* No licenses, are required. Licenses are required for all
other installations
i:\Dsts\Permit Forms \ElcPermitAppPg2.doc 01/03
CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
GENIE ELECTRIC CONSTRUCTION
8701 SE 156TH AVENUE
PORTLAND, OR 97236
Electrical Signature Form
Permit #: ELC2003 -00567
Date Issued:
Parcel: 2S112DC -01500
Site Address: 15757 SW 74TH AVE BLD D
Subdivision: FANNO CREEK ACRE TRACTS
_Block: _ Lot: 006 _ -- - -- -
Jurisdiction: TIG
Zoning: I -
Remarks: Install (2) branch circuits
Your company has been indicated as the electrical contractor for the permit indicated above. In order for the
electrical permit to be valid, the signature of the supervising electrician is required. Please have the
appropriate individual from your company sign below and return this Electrical Signature Form prior to the
start of the work to the address above, ATTN: Building Division.
No electrical inspections will be authorized until this completed form is received
OWNER: ELECTRICAL CONTRACTOR:
74TH AVENUE INDUSTRIAL PARK LL GENIE ELECTRIC CONSTRUCTION
8100 SW DURHAM RD 8701 SE 156TH AVENUE
TIGARD, OR 97224 PORTLAND, OR 97236
Phone #: Phone #: 503 - 762 - 9296
Reg #: LIC 56639
SUP 4536S
ELE 34 -488C
AN INK SIGNATURE IS REQUIRED ON THIS FORM
x -
Si natur� Supervising Electrician
9 p 9
f you have any questions, please call 503.718.2433.
Sep 17 03 09:41a GENIE ELECTRIC 503 -762 9188 p.l
CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
GENIE ELECTRIC CONSTRUCTION
8701 SE 156TH AVENUE
PORTLAND, OR 97236
Electrical Signature Form
Permit #: ELC2003 -00567
Date Issued:
Parcel: 2S112DC -01500
Site Address: 15757 SW 74TH AVE BLD D
Subdivision: FANNO CREEK ACRE TRACTS
Block: Lot: 006
Jurisdiction: TIG
Zoning: I -
Remarks: Install (2) branch circuits
Your company has been indicated as the electrical contractor for the permit indicated above. In order for the
electrical permit to be valid, the signature of the supervising electrician is required. Please have the
appropriate individual from your company sign below and return this Electrical Signature Form prior to the
start of the work to the address above, ATTN: Building Division.
No electrical inspections will be authorized until this completed form is received
OWNER: ELECTRICAL CONTRACTOR:
74TH AVENUE INDUSTRIAL PARK LL GENIE ELECTRIC CONSTRUCTION
8100 SW DURHAM RD 8701 SE 156TH AVENUE
TIGARD, OR 97224 PORTLAND, OR 97236
Phone #: Phone #: 503 762 - 9296
Reg #: LIC 56639
SUP 4536S
ELE 34 -488C
AN INK SIGNATURE IS REQUIRED ON THIS FORM
x ' - -
SignaturEZf Supervising Electrician
f you have any questions, please call 503.718.2433.
Sep 15 03 04:37p GENIE ELECTRIC 503 -762 9188 p.3
CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
RECEIVED
IMPORTANT PERMIT NOTICE
SEP 16 2003
GENIE ELECTRIC CONSTRUCTION CITY OF TIGARD
8701 SE 156TH AVENUE CITY
DIVISION
PORTLAND, OR 97236 i2
Electrical Signature Form
Permit #: ELC2003 -00567
Date Issued: -
Parcel: 2S112DC -01500
Site Address: 15757 SW 74TH AVE BLD D
Subdivision: FANNO CREEK ACRE TRACTS
Block: Lot: 006
Jurisdiction: TIG
Zoning: I -P
Remarks: Install (2) branch circuits
Your company has been indicated as the electrical contractor for the permit indicated above. In order for the
electrical permit to be valid, the signature of the supervising electrician is required. Please have the
appropriate individual from your company sign below and return this Electrical Signature Form prior to the
start of the work to the address above, ATTN: Building Division.
if No electrical inspections will be authorized until this completed form is received
OWNER: ELECTRICAL CONTRACTOR:
74THAVENUE INDUSTRIAL PARK LL GENIE ELECTRIC CONSTRUCTION
8100 SW DURHAM RD 8701 SE 156TH AVENUE
TIGARD; OR 97224 PORTLAND, OR 97236
Phone #: Phone #: 503 -762 -9296
Reg #: LIC 56639
SUP 4536S
ELE 34 -488C
AN INK SIGNATURE IS REQUIRED ON THIS FORM
X
Si 9 naturAf Supervising Electrician
If you have any questions, please call 503.718.2433.
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received 1 � J 7 , q at Requested i Z/ 12/0 — AM PM BUP
Location / '7 S 7 "2 q`''' Suite MEC
Contact Person )4)44 C Z /" Ph ( ) 7,'/9 ----' 7 / r
Contractor Ph ( ) SWR
BUILDING Tenant/Owner CS 06 J 5(o 7
Footing
Foundation ELC
Access: , Ili --3,
Ftg Drain i" ` ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Fi rewal I
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
",ASS _ P FAIL
PL MAIN'
Un•"
Rout
Wate ice
Sanita - Sewer
Rain rr :,'ns
Cate = ° / Manhole
Stor .. Dr. •
S °IA,- er Pa
O _ .
Fi , I --
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
m 0 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
"-1= PART FAIL
E Please call for reinspection RE: 0 Unable to inspect — no access
Fire Supply Line I
ADA �
D , j Inspector i . L - . Ext
Approach/Sidewalk
Other: 1
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL