Permit C ITY OF TIGARD.' ELECTRICAL PERMIT
PERMIT #: ELC2004 -00097
DEVELOPMENT SERVICES DATE ISSUED: 3/1/04
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S114A0-01500
SITE ADDRESS: 17005 SW 92ND AVENUE
ZONING: R - 12
SUBDIVISION:
BLOCK: LOT : JURISDICTION: TIG
Project Description: Wire equipment in concession stand, (10) branch circuits.
Job No. 571
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: 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:
TIGARD, CITY OF WILLAMETTE ELECTRIC INC
13125 SW HALL PO BOX 230547
TIGARD, OR 97223 TIGARD, OR 97281
Phone: Phone: 503 - 624 -3631
Reg #: LIC 75059
SUP 1965S
FEES ELE 34 -283C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 3/1/04 $106.70
[TAX] 8% State Surcharge 3/1/04 $8.54 Rough -
Elect'l 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 OA - : -se -6110 through OAR 952 -001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503) 246 -6699 or
1- 800 -33. -2344.
Issue. By: itite/ i' / � > 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: 4 Z - � �`—`� DATE:
LICENSE NO: /?66
Call 639 -4175 by 7:00pm for an inspection the next business day
Electrical Per iti:E./404 .' -:. `It°0' Received n ' i,4 - • - Ar FOR OFFICE USE ONLY
, e - , ...
Electrical
Date/B : „, Aril Permit No.: ,..e.•# '''' 4/00,F/
City of Tigard NOR 1 '6°4 Planning Appr e va
Date/By: Permit No.:
13125 SW Hall Blvd. O TICIARQA Plan Review Other
Tigard, Oregon 97223 Gil' e F
ta- . ' Date/By: Permit No.:
Phone: 503-639-4171 Fax: Mg _ _ I Post-Review Land Use
400 i , A Date/By: Case No.:
Internet: www.citigard.or.us l k A II Contact Juris.: El See Page 2 for
24-hour Inspection Request: 503-639-4175 `"--"' --4 Name/Method: Supplemental Information.
P Mantlat:4;:: 1:1.VOINVOIM•MR:WCO:ilfilatl itaatiV~WWW2003VONVIIC4AiliarVINI:4
Eil New construction 111 Demolition 0 Service over 225 amps- 0 Health-care
commercial 0 Hazardous location
t4 Addition/alteration/replacement El Other: , _ , Service over 320 amps-rating of 0 Building over 10,000 square feet,
amtuctamoram,movAlitottowerfK;nt 1 & 2 family dwellings four or more residential units in
0 1 & 2-Family dwelling al Commercial/Industrial ci System over 600 volts nominal one structure
El Building over three stories 0 Feeders, 400 amps or more
[11 Accessory Building LI Multi-Family 0 Occupant load over 99 persons 0 Manufactured structures or RV park
ILI Master Builder 111 Other: 0 Egress/lighting plan 0 Other:
MialifiCORVEMOMOUtWria131eVIDVPNWIM Submit sets of plans with any of the above.
Ain The above are not applicable to temporary construction service.
Job site address: / i706 c S L) 9 2_ ---- 4 ii-e_ 'Ail17,':,73:A'4.'.i*fttrAiMgt$:MDf2W,MG73.aittinfg
Suite #: n l31c1 ./Apt.#: Number of inspections per permit allowed
Project Name: (1 6 K._ V °ult. V___ (c.AAJCIS ta Ati Description Qty Fee (ea.) Total
New residential-single or multi-family per
Cross street/Directions to job site: dwelling unit. Includes attached garage.
Service included:
1000 sq. ft. or less 145.15 4
Each additional 500 sq. ft. or portion thereof 33.40 1
Limited energy, residential 75.00 2
Subdivision: / # Limited energy, non residential 75.00 2
Tax map/parcel #: , i /41-0--o/svo Each manufactured home or modular dwelling
witaaa ,:luti service and/or feeder 90.90
2
Services or feeders - installation,
(ALiT: e 9r, , e 0-1A.,,Lit (0%
—4 0", ce r..■ (,,.:, \-- alteration or relocation:
ib" am
200 amps or less
201 amps to 400 amps 80.30
106.85 2
A cr
2
401 amps to 600 amps 160.60 2
Mirekett inn3Vtiail,i!, Over amps to
amps or amps 240.60 2
ps or volts 454.65 2
Name: Reconnect only 66.85 2
Address: Temporary services or feeders - in
alteration, or relocation:
City/State/Zip: 200 amps or less 66.85 1
Phone: Fax: 201 amps 10 400 amps . 100.30 2
, t .
, , 401 to 600 amps 133.75 2
11-3 '''' Branch circuits - new, alteration, or
Name: extension per panel:
A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 6.65 2
City/State/Zip: B. Fee for branch circuits without purchase of cif, S
service or feeder fee, first branch circuit 46.85 i icd 2- .2
Phone: Fax: Each additional branch circuit • 6.65 t ccji 1A 2
E-mail: Misc.(Service or feeder not included):
itL:VTMESXAC#5 010 Tt. ;M!' EEaaccitit or irrigation circle
P si u g■ l i n i P or outline lighting 53.40
53.40 2
2
Job No: S- / Signal circuit(s) or a limited energy panel,
alteration, or extension Page 2 2
Business Name: I 1( 4 0.,,..ate A,, c /,..,, , Description:
Address: Af) 6)X 2, 0 g t-t 2
Each additional inspection over the allowable in any of the above:
City/State/Zip: 7, c A-I 0, 9?-z_k- 1 Per inspection per hour (min. 1 hour) 62.50
Phone: 6, ZA/ - 3 b Fax: 62_11 — - Z_Cf 3 investigation fee:
Other:
CCB Lic. #: 2-5-6) Lic. #: 3 y - zis 3 (.___ ;?4:=S486'iCWIMPATeatirigaiiTiigia.:';4:24;14.4*';AA:::il
Supervising electriciank ,70:::.0 Subtotal $ /6 6, lc,
signature required: ‘4 Plan Review (25% of Permit Fee) $
Print Name: 44 - 1-, (..-e 'lie. #: /96 ,--- ----. State Surcharge (8% of Permit Fee) $ 6- 51'
TOTAL PERMIT FEE $ a . 5 -- , 24
Authorized Notice: This permit application expires if a permit is not obtained within
Signature: Date: 180 days after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
(Please print name)
i: \Dsts \Permit Forms \ElcPennitApp.doc 01/03
Electrical Permit Application - City of Tigard e
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
El Burglar Alarm
n Garage Door Opener
0 Heating, Ventilation and Air Conditioning System
n Vacuum Systems
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
n Clock Systems
n Data Telecommunication Installation
n Fire Alarm Installation
n HVAC
n Instrumentation
n Intercom and Paging Systems
n Landscape Irrigation Control
Medical
n Nurse Calls
Outdoor Landscape Lighting
Protective Signaling
IT 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 24 -Hour
BUILDING Inspection Line: .(503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received �� � Date Requested AM AM PM BUP
Location 1 Di A 2/ 1''e- ' Suite p MEC
Contact Person t /�/ ✓ Ph (53)f -- d PLM
Contractor Ph ) — D 6 �O SWR
BUILDING Tenant/Owner �.� ��, �� ELC � COO9
Footing / ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath /Shear
Framing
Insulation rjL ^/ —
Drywall Nailing lT 1L i 1 �/
Firewall
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
ASS •ART FAIL
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage .
Fi m
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA 7-- - ®�
Approach/Sidewalk Date 3 Inspector / _ YI r 1. Ext
'Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL