Permit ..4
CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2009 -00417
1 3125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/13/2009
TIGARD Parcel: 2S 101 AB02703
Jurisdiction: Tigard
Site address: 7450 SW BEVELAND RD 100
Subdivision: MCA OFFICE BUILDING Lot: 27
Project: McCaffery & Associates
Project Description: Reconnect only.
Owner: FEES
MCCAFFERY & ASSOCIATES Quantity Description Date Amount •
7450 SW BEVELAND ST, STE 100
TIGARD, OR 97223 1 ea Reconnect Only 08/13/2009 $66.85
PHONE: 1 ea 12% State Surcharge - 08/13/2009 $8.02
Electrical
Contractor: .
SAM HARDING INC
23833 NE GLISAN
WOOD VILLAGE, OR 97060
PHONE: 503 - 492 -3697
FAX: 503 - 492 -3978
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $74.87
Required Items and Reports (Conditions)
•
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work wilt
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 the 180
days. ATTENTION: Oregon law requires you to follow the 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 a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: d Permittee Signature:
6 7
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' 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.
' X 08/12/2009 19:56 5034923978 SAM HARDING INC PAGE 01
Electr Permit t App
mate received:4 / g • t!'�• t 'ermit no. &CC. 00 — / / '
,:k.I'L�' City of Tigard i l ,, p
I _ProjecUappl, no.. Expire date:
•
City of Tigard Address: 13125 SW Hall Blvd. Tigard, OR 97223 Date issued: By: Rcccipt
Phone: (503) 639 -4171 AUG 1 3 2009
Fax: (503) 598 -1960 Case file no.: Payment type;
Land use approval:
CITY OF �I to ,
1e. rh y � it � !(�
au!LUII' 2 Di vi�.i# j-.
TYPE OF PERMIT
•
❑ 1 & 2 family dwelling or accessory 'Commercial/ industrial ❑ Multi - family ❑ Tenant improvement
0 New construction 0 Addition /alteration/replacement 0 Other: ❑ Partial
JOi1 SITE INFORMATIONi
Job address: / ;; - t Bldg. no.: Suite no.: . 0/ Tax map/tax lot/account no.:
Lot: Block: Subdivision:
Project name:,ef C /, a, F i S"9C Description and location of work on premises: /
Estimated date of completion/ins. tion: Z e . e •
(O KA(:TOR. APPLICATION FEE SCI iEDIILE
Job no: Fee Max
$ ! s 1 - . v ''i".I�iM.leI! - lam. Al Description Qty. (ea) 11421 no. insp
Nair residential - sitegte or multi- family per
Address: 238J3 NE G1i.san dwelling unit. Includes atmchcdmace.
II
City: Wood Vi11a.e Stater. ZIP: 97050 Servlcelnciuded:
1000 sq. ft. or less 6
Phone _ M - • Ea a dditions] 500 sq. ft. or portion thereof
CCB no.: Elec. bus. lic. no: _ -
I _ =
Limited energy, residential l
City /m- • lic. no.: 14 , 3 Limited energy, non- residential MOM
�� 5' • 5 Each manufactured home or modular dwelling
Signature of supervising electrician (requi -.r Date Service andior 2
Sup. elect. name (print); _ 1 .. • as _ a ' i a Licenser*: _ r Services or feeders - installation,
a or r elocation: II
PROPERTY OWNER 200 amps or less ■ 2
r - r 201 amps to 400 amps �_� 2
�" 401 amps to 600 snips 11111_11= 2
Mailing address: , P...
601 amps to 1000 amps 111.111.1111
'City: State: ZiP: Over 1000 amps or volts ___ 2
Phone: Fax: Reconnectonl Ill MME /,�
Owner installation: The installation is being made on property I own Temporary serrices feeders - , -
which is not intended for sale, lease, rent, or exchange according to installation a lteration, orrelocationr
ORS 447,455, 479, 670, 701, eon ampsorlcss � ■ 2
201 amps to 400 amps IIIIIIIIIII 2
Owner's signature: Date: 401 to 600am.s =111
ENGINEER Branch circuits- nen, alteration,
Name: or extension per panel:
A. Fcc for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
$Lte: • ZIP B. Fee for branch circuits without purchase
of service or feeder Ice, first branch circuit: 2
Phone: E - mail: Each additional branch circuit: IIIM_MIll-
I'LN11 )ti ViEW(]'lease [-heel; all that apply) Misc. (Service or feeder not Included):
OServiceover commercial 0 Health - care facility Eachpurnpor ■■ 2
O Service over 320 amps - rating of I &2 0 Hazardous location F+en signor outline lightting ___MEM
farnil y dwellings ❑ Building over 10.000 square fact four or Signal circuit(s) or a limited energy panel.
O System over 600 volts nominal mom residential units in one structure alteration, or extension 11111.1 2
❑ Building over three stories ❑ Feuiers, 400 amps or more 'f)ecri lion;
❑ Occupant load over 99 persons ❑ Manufactured structures or RV park Each additional Inspection over the allowable in any of the above:
O Egress/lightingplan ❑ Other perinspection _Milli Submit sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other
Not all 'urisdiction! a edit cads, lease call oriatilctlon foe mor inf omwtion. Permit fee $ LPL,
1 accept p 1 Noti This permit application
❑ Visa El MasterCard expires if a permit it not obtained Plan review (al. _ %) $ , -
C,etl slant n I within 180 days after it has been State surcharge {3. ) •... $ g; 4
Expires accepted as comp lcm. TOTAL, $ 71y t 8? 1/
Name of cardholder as shown Ott credit card
$
Cardholder sirinture Amount
44 0-4615 (6100ll;OM}
08 -10 -2009 06:26Ak1 FROM- ` OL 'J 3 /1 Q b ILI
6t{ Z,9 3 6 3 HpM� T -070 P.001 /001 F -912
jJ(» 503-736 -- 'moo 'VW 5a3 -- 736 5 I
"may Request to Energize an Electrical Installation PH Yrt.l s
Pi") � 2� K RS 7z our p•r�T �• 12• q ®3,��
f 53 �7 2
K-14: CALL Fp& 4 N 5 (11'z ' � .� 1 L 7J
REQUESTING SUPE VISING ELECTRIC INFORMATION _
Name of supervising electrician: 7 ^ Date of request: 9"/ 1 I-
Supervising electrician's license number: 3 c, 5 _ Date installation was completed: a 144 i 200
Electrical permit no.: If a r emora►
f p y permit is posted at the jab siia:, please include a copy of it with lhis fnrm,
_ EMPLOYING ELECTRICAL CO iNFC)ItMATION
Name of electrical contractor: SAvt 4-161 106.. License no: 66 _ 54.96,
Business address: '" -
L i
City: State: CE., ZiP: ° .7CYaO
Phone: ti'3 -44i. - 30 y Fax: c rj3 - - 3678 E -mail: 51,� i atZ411. ,t
C UST MER I NFORMATION _ __
Customer's name: _CA -
Customer's address:
= 1� s _ 'V zt, 4-
City: - r- 1(„ARD 1 4S0 State:_ pe ZIP: q 7ez 5
Address of installation if different than customer's address:
City:
State: ZIP:
INSPECTING AUTHORITY INFI]RMATIG 1.1
Authority having jurisdiction to inspect: � poi Phone: 5 -4/9.4/7/
Address: / / 14.461-- &.V7
City: ( ,p _ State: ZIP :
RECEIVING ELECTRIC UTILITY INFORM /V[[0N
Name of electric utility receiving request: - p4 Phone: 5b3 - ,
7,4 - S4
Address:
-
City: ,_
State: _ (�yj _ .21P:
REASON FOR REQUEST
A. Restoring electrical service that was interrupted or disconnected because of'eithor a:
❑ Service change or yUncontrollable event, such as fire, flood, or severe weather;
Or
B. Electrical service at a remote location needs to be:
Initialized Restored
COMPLETION' INSTRUCTIONS AND SIGNATURE
Supervising electrician Electrical contractor
Note: After sending this form to the electric utility Note: By close of busines on the first business day following
named above, you must send a copy of this form to: energizing of a completed installation in response to the above
(1) the electrical contractor, (2) the customer, and request, you must; (1) noti fj' the authority having jurisdiction
(3) the inspecting authority, that the installation has bee n energized, and (2) request that the
authority inspect the compl installation.
Supervising electrician's signature Dam '
Eiectric utility
Note: Please consider noti Eying the inspecting authority
. --
r identified in this request when an installation is energized
/ • , - ,; 4
� ; ,.b' .re inspection,
, , , t 6 2 I ,
tom
440.0948- COM(I 0/01i/COM AUG 1 2009
CITY OF TIGARD
BUILDING DIVISION