Permit r CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2005-00269
DEVELOPMENT SERVICES DATE ISSUED: 4/21/2005
° '' I 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S104BB -08100
SITE ADDRESS: 14200 SW BARROWS RD ZONING: C -C
SUBDIVISION: RUSSELL'S SCHOLLS FERRY LOT : 004 JURISDICTION: TIG
Project Description: (4) branch circuits - video poker room.
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: 3 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:
BARROWS CROSSING LLC WILLAMETTE ELECTRIC INC
2650 SW 41ST PO BOX 230547
REDMOND, OR 97756 TIGARD, OR 97281
Phone: Phone: 503 - 624 - 3631
FEES Reg #: LIC 75059
Description Date Amount SUP 19655
ELE 34 -283C
' [ELPRMT] ELC Permit 4/21/2005 $66.80
[TAX] 8% State Surcharge 4/21/2005 $5.34 REQUIRED ITEMS AND REPORTS
Total $72.14
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: i_� s Permittee Signature: - . - �Q
4
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 503 - 639 -4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
APR 20 2005 6:55AM HP LASERJET 3200 p.2
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Electrical PermieAppliq r D e ci FOR OFFICE USE ONLY ,
City of I igard '�' n tt 7 " "D '� G''2 9 Q , E
P ermit Na.:
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Other Permit
Phone: 503.639.4171 Fax: 503.598.1960 APR 2 O '10 e � ''A"7adi'+I'`'. DateDale/E1 Inspection Line: 503.639.4175 1 „ Date Ready/By ® See Page 2 for
Internet: www.ci.tigard.or.us C! 0 Notifiechmethod: Supplemental information
,. -•„ .a, i ,�„ r > , m° K n ,,rtsw: t.tpa ,,.. P ,.,, y - tf . -
,Sr S' 1 , ' 9 t r, r - ? ;i.;' , :ta^ € t ja a 3 .L- t '1a'4 : .t .sqv ,..
s kr z& l p 4 Yt> - +', n x r rh
i �' i � ;13 �i,� a1.n���tz>�t�titrm���,.�... .h r,4exa���'�7`_°t r s?z t� t5 • m t.x C- ..�w•...,` „ . •i .:� r �`: -
❑ New construction C I Addition/alteration /rep acement Please check all that apply:
❑Service over 225 altips, comm'l ['Hazardous location
❑ Demolition ❑ Other
❑ Service over 320 amps - rating ❑ Buiidng over 10,000 sq. ft:,
` . I lit 1 l in t 1 2 s 211 1 1i 0 .r ` ? r' £ t . -.1 ? 1 of 1- and 2- family dwellings 4 or more new residential
❑ 1 - and 2 family dwelling • '4 Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑Building over three stories ❑ Feeders, 400 amps or more
❑ Multi family ❑ Master builder ❑ Other: ❑Manufactured structures or
6 ao� c.; a ❑Occupant load over 99 persons
- "- l m ' 4. , s li d y>A s g .u� f , f .' , t, �W'yJ 1t �, 4,"i ' Y til 1W park
' A lki .414:11'1'0' iitii6 i t `efil ith'i::ibt ikie, 1P ; , ;13� - a.'1 d ❑ - g ress.- g --- -g plan
p ne �� ❑Health -care facility ❑Other:
Job no.: Job site address: 14 p S P :tna nr.. S L Submit 2 sets of plans with any of the above.
, City/State/ZIP The above are not applicable to temporary construction service.
t =u s � 1t
7 /• �#��1��t�.t W� �,th �` � l i :rye �t d .�- ��';�µ ; * i•�.. '' '..
Suite/bldgJapt no.: ,
Project name: Coe( [� D f u.,:i - , .•
t[!dA 1- 4tLt.& l 1 2Lc. Descrlptien Qty. Fee. T°tat
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 4
Subdivision: 1 Lot no.: Ea. add'i 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
Tax map/parcel no.: Limited energy, non- residential 75.00 2
i i<' ° R ,.� �R s � s sr y. • pa 'E' e � �u1 � r.. m� , a l � s� i� l s,y� d 9 � , . �hr [s� t ��.
#gi t t t .s �E,{ i71 �th y try y tt 0 t � Q , ¢tl Ot t u ., x t' E ai 4 ,' N e i =rY1 i . Ea ch manu or mo
aex_.�, ! �a-7m 4. . c:E ;f, a?a tl._.r. 4t.01k' 1L' r__"z,r,.•..r, ki A , 4,:�. z2:_.s,.5 -:.
• /� dwelling, service and/or feeder 90.90 2
Ut j3 �+ rd °EA-. ( ri.i.N Services or f eeders installation, alteration, and /or relocation
• 200 amps or less _ 80.30 2
a
� tit rt �rt,s v:1 i + t, t rt <za t .a i >:, 201 atttps to 400 amps 106.85 2
It {1 S LiAta (A ,4 ,�a y �7 tl rsi , ie!e , km l l ' , x' Nom'
°~ 1 st " 'r ""� 401 amps to 600 amps 160.60 2
Name: 601 amps to 1,000 amps 240.60 2
Address: Over 1.000 amps or volts 454.65 2
Reconnect only 66.85 2
City / State/ZIP: Temporary services or feeders installation, alteration, and/or
Phone: ( ) I Fax: ( ) relocation
200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 snips to 600 amps 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
k f n l +phi I l.Ni.prti , }t.n ° ) ° Eft ', x mMT . i ,:e rr iii A. Fee for branch circuits with
l gaglOp .�,., d a i.irn,: ,, - A A rdzGts € hi r z E , itili lrti :'. , , service or feeder fee, each
Business name: branch circuit 6.65 _ 2
B. Fee for branch circuits
Contact name: without service or feeder fee,
each branch circuit 46.85 y� S-.. 2
Each add'l branch circuit _ 3 6.65 !q y f' - 2
City /State/ZIP: Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: ( ) 1 Fax: ( ) Sign or outline lighting 53.40 2
B -mail: Signal circuits) or limited -
s k , a. t �, r P a j•lr ', it t f r i s` b .1? i , «r sari .t�' ` t�� m - t1 t ' 61 ,�2 energy Panel, alteration, or
' R ?j SJ: i , ,� l ")d>l'�.:s,d]!, 1 extension. Describe: Page 2 2
Business name: tj, R aLw,R
Address: 641.A Each additional inspection over allowable in any of the above
2...4 t+ cY Per inspection 62.50
City /State /ZIP: r, 9 14,2 n 0 ,. ?,7 zff / _ Investigation per hour (t hr min) 62.50
Industrial plant per hour 73.75
Phone: (.S"7� ) t9, c 3 / Fax (. r ) C2, 5( - Zc✓s'� 1 ti qp n1; rrin1 d u y f p 7 t 8 1 - - rMrdi� .•.,g: .. .:i ,
• s ue t,t , "o� "rEgk ii! -- . W.-.•.4-il.Q.t'-flfi�l_�, s ..),,,
CCB Lic.: 7 i - 0 S 4 - Electrical Lie.: ''c _ Zk jc . Suprv. Lie.: /9 r S Subtotal 4 g,.
•
Suprv. Electrician signature, required: Plan review (25% of permit fee)
State surcharge (8% of permit fee) S''• t y
Print name: Date: °i - 2_6. c
�, ' TOTAL PERMIT FEE .7 e t / l f
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: Date: • Fee methodology set by Tri- County Building industry Service Board
•r Number of inspections per permit allowed.
f: 1BUildiag \Pormits\BLC- PumaApp.doe 12/03 440- 46iSr(i0/02/COM/WEB
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2005-00269
13125 SW Hall Blvd., Tigard, OR 97223 f DATE ISSUED: 4/21/2005
Phone: (503) 639 -4171 .����ad4jmNPupfi�lw�
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 4/28/2005 TIME: 7:24AM PAGE: 58
SITE ADDRESS: 14200 SW BARROWS RD CLASS OF WORK:
hi
. SI SUBDIVISION: RUSSELL'S SCHOLLS FERRY LOT #: 004 TYPE OF USE:
PROJECT NAME: GODFATHER'S PIZZA
DESCRIPTION: (4) branch circuits - video poker room.
OWNER: BARROWS CROSSING LLC, PHONE #:
CONTRACTOR: WILLAMETTE ELECTRIC INC PHONE #: 503 - 6243631
Inspection Request Scheduled For: Date: 4/28/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 005564 -01 503-624-3631 N
Corrections /Comments / Instructions:
•
os
PASS n PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: Phone #: (503) 718-