Permit CITY OF WARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00359
. DEVELOPMENT SERVICES DATE ISSUED: 6/17/2004
I
13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171
PARCEL: 1S136DD
SITE ADDRESS: SW NO ADDRESS
SUBDIVISION: ZONING.
BLOCK: LOT : JURISDICTION: TIG
Project Description: 1 service and 2 branch circuits for ramp meter signal at Haines Street southbound on - ramp.
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: 1 " W /SERVICE OR FEEDER: 2 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:
OREGON DEPARTMENT OF TRANSPORTATION TICE ELECTRIC
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FINANCIAL SERVICES PO BOX 15009
355 CAPITOL ST NE RM 434 2139 SE BELMONT ST
SALEM, OR 97301 PORTLAND, OR 97293 -5009
Phone: 503 - 667 -8834 Phone: 503 - 233 -8801
Reg #: LIC 166
SUP 2586S
FEES ELE 26 -126C
Description Date Amount
Required Inspections
[TAX] 8% State Surcharge 6/17/2004 $7.49
CITY OF TIGARD MENU 6/17/2004 $93.60 Elect'l Service
Rough -in
Total $101.09 Elect] 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 • in i' - 952- 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503)
246-6. • or 1 -800 -332 -2
Iss ed By: s!■1a / . Permit Signature: _- , Vi +liNIF
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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: 05 8(.2
Call 639 -4175 by 7:00pm for an inspection the next business day
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06/14/2004 09:08 503 -872 -8290 TICE ELECT.SERV.DEPT PAGE 02
•�,� ��� °O • '� FOR OFFICE USE ONLY .
k .'E __ _4:a ______rmLIIkp_0 a ZQ)CI Received //-- / o Electrical
\._ I — % 4 Date/By: GG
100 y= (� `f I p ermit No — ao 357
,
City of Tigard Sign —
Date/3_,V: Permit No.: •
1 3 125 SW Hall Blvd. NI O � - (1G�` S � � Date/
Plan • Rev Other
Tigard, Oregon 97220, IDN By: Permit No.:
Phone: 503 - 639 - 4171 ) \1 P.,55031595.1960 Post - Review Land Use
gar 13, 5 tv {.t' + (t\ Pale/By; Case No.:
Internet: www,c —
i .t i d.or.us �,� Ju ris.:
24- hour inspection Request: 503- 639 -4175 ' ,«.�!' - f- - Contact (p pee ant 2 far
p q Name /Method: Supplemental Information,
• aim TYPE OF WORK - PLAN REVIEW (Please check ail that apply)
• - .1 New const'ructiori
• El Servict over 225 amps- ( 1leallll -care facility
Iti
Y
t, commercial
II Addition/aiteration/re a lacement i Other: Hazardous location
Service over 320 amps- rating of ❑ Building over 1 0,000 square fee..
CATEGORY OF CONSTRUCTION I & 2 family dwellings four or more residential units in
• I & 2 -Famil dwellin • lxi commercial/Industrial 0 System over 600 volts nominal one structure •
• ACCe5S0 Building El Building over three stories ❑ Feeders, 400 amps or more mg Occupant load over 99 persons D Manufactured structures or RV park k
.• Master Builder • Other: D Egress/lighting plan 0 Other:
JOB STT5 rnrr ^a ad mr'nrt n...1'r.f1CA.TjQN.: t Submi sets of plans with any of the above. .
`— "" R
s
dd
Job site a reg: l SIrtP�� -' - C - L1/4..) em porary construction above are not a to temporary ser ice.
_ .
,...•- .__... ' ' FEE * - SCHEDULE
Suite #. � Bidg. /Apt, #: _ Number of inspections per permit allowed_ ;
Project Name: Ramp meter traffic signal service ❑ Qty Fee lee -) Totes
& caxcults New residential - single or multi - family per �
Cross street/Directions to job site: dwelling unit. Includes attached garage.
Haines St on ramp south bound to 1-5 Service Included:
1000 ss. ft, or less 145.15 4
Each additional 500 sq. ft. or portion thereof 33.40 I
_
i Subdivision: . Lot #: Limned energy, re 75,00 2
Limited energy, non residential 75.00 2
Tax map /parcel #: I S ?)(45Tip p - LIO Each manufactured home or modular dwelling
. DESCRIPTION.OF WORK . • • . '. •• • service and/or feeder 90,90 2
Ramp meter traffic signal /circuits & service S yr feeders - itallaRon,
alt or relocatio
�� 200 amps or less 1 80.30 80.30 2
- 20) amps to 400 amps 106,85 2
• 401 snips to 600 amps 160.60 2
CI PROPERTY OWNER TENANT 601 amps to I 00 s 240.60 2
Over 1000 amps or volts 454.65 2
Name: (, Reconnect only 66,35 2
Address: c #14A,.1Ct A.& .ti!) 356" WiroL brpit W1 934 temporary services or feeders - installation,
/ alteration, or relocation:
City /State /Zip: `•fvu,1•4 Oci q-1 301 - - 200 amps or less 66.85 I
' 'Phone • * .,,_.. • ta Fax:. 201 amps to 400 amps 100.30 _ 2 •
• w APPLICANT ' . 12 CONTACT:PERSON` '!-'i:. 401 to 600 emu 133,75 2
• B rane h C - pew, alteration, or
N ame: , �,,, * ._ _ a' • extension per panel:
Address: A Fee for branch circuits with purchase of
service or feeder fee each branch circuit 6.65 13 .30 2
City /State /Zip: B. Fee for branch circuits without purchase of
service or feeder fea first branch circuit 46,85 2
. Phone: Fax: Each additional branch circuit 6.65 1 2
E-mail: . . Misc.(Service or feeder not included):
CONTRACTOR , Each pump or irrigation circle 53,40 2
- Each sLit or outline li;hlin: 53.40 2_
Job No: Signal circuit(s) or a limited energy panel,
Business Name: Tice Description:
or extension Page 2 _- 2
ice Electric CO. Description:
Address: PO Box 15009 _.__
Clt /State /Z1 .Portland OR 97293-5009 Each additional inspection over the allowable in any of the above:
y p Per inspection per hour (min. 1 hour) 62.50
I Phone: S03- 233 -8801 Fax: 503-872-8290 Investigation fee:
CCB Lie. #: 166. Lie. #: 26 -126C ocher
E lectrical:Permit:Fees* • : '
Supervi eleCtrician Subtotal $ 93.60 ___c_.1 signature required Plan Review (25% of Permit Fed . $
Print Name: John _,,T hie 1 nnr. Lie. #: 79,a6s _ State Surcharge (8% of Permit Fee) g 7 49 . _
TOTAL PR.MJT FEE S 1 0.1,09 - - 1
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 \ElcPerrnitApp.doc 01/03
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CITY OF TIGARD 24 -Hour
BUILDING Inspection Line:„ (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received „' I te � � Daate Requested -
AM PM BUP
Location r v O R. ESS Suite MEC
Contact Person DO (3 Ph ( ) 3'4( -7336 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC a00 1 / - 6 6 .5?
Footing
Foundation Access: ELC
Ftg Drain . ELR
Crawl Drain
Slab Inspection Notes: / s / 22, 6 rue. SIT
Post & Beam
Shear Anchors 6 )6 ( .-t. �/
Ext Sheath/Shear 1/
Ina Sheath /Shear
Framing
Insulation
Drywall Nailing M (�
Firewall , l �L 5. GEC
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
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Roof'
Other: •
Final =1e? 11/VO
PASS PART FAIL
PLUMBING A Fl I
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer ► tiL a, t I ' D 77/ 0 B
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
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Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
'ough-In M
UG /Slab
Low Voltage
Fire Alarm
Fi Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
�► a PART FAIL
S 0 Please call for reinspection RE: 111 Unable to inspect – no access
Fire Supply Line Q I GQ c p
ADA D ate v ✓ 0 LI Ins ector — J(ir PPI/aa Ext
Approach /Sidewalk P
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL