Permit 1 C'- eta'i - r/. /- / -
.I C/ ELECTRICAL PET
S� 4• C 0 ®F T GARD PERMIT #: ELC2003 -00704
DEVELOPMENT SERVICES DATE ISSUED: 12/5/03
--° 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2 S 102AD -01300
SITE ADDRESS: 09095 SW BURNHAM ST
SUBDIVISION: ZONING. CBD
BLOCK: LOT : JURISDICTION: TIG
Project Description: Install 13 branch circuits. 1 - 21 - 04 add 10 circuits and low voltage Data and TV.
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: 22 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:
WYATT, DEWEY CAMERON THOMAS LLC
c/o WYATT, EUGENE P.O. BOX 5324
9095 SW BURNHAM ALOHA, OR 97006
TIGARD, OR 97223
Phone: Phone: 503 - 629 - 8938
Reg #: LIC 138773
ELE 34 -526C
FEES SUP 4633S
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 12/5/03 $126.65
[TAX] 8% State Surcharge 12/5/03 $10.13 Low Voltage Inspection
[ELPRMT] ELC Permit 1/21/04 $216.50 Rough -in
(additional fees not listed here) Elect'I Final
Total $370.60
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: /a/& �� � 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: DATE:
LICENSE NO: r 33
Call 639 -4175 by 7:00pm for an inspection the next business day
C( Ce-dS
Electrical Perm j.k=t % u.',., ,On FOR OFFICE USE ONLY .
City of Tigard , ® Date/By d �/ . Permit No O ` r t5
13125 SW Hall Blvd., Tigard, OR Plan Review
223 '
Phone: 503.639A171 Fax: 503 6 1 q � 'ET�N Ai t i +'r'\ DateB' : Other Permit:
Inspection Line: 503.639.417 `U s^- r e` Date Ready/By: Juris. El See Page 2 for
IntInternet: www ci.tigard.or.us CITY OF T1G D Notified/Method: Supplemental Information
5114
"'.r ,,...,. .1 f 1 S1 k PLAN REYIEWa ,
❑ New construction ddition /alteration/replacement Please check all that apply:
❑ Demolition ❑ Other: ['Service over 225 amps, comm'l ❑ Hazardous location
P Y ❑Service over 320 amps — rating ❑ Buildng over 10,000 sq. ft.,
£ ii . ; GATEGOreilCONSTRV41(0 " 1�v r :At of l- and 2- family dwellings 4 or more new residential
❑ I- and 2 family dwelling Commercial /industrial ❑ Accessory building ['System over 600 volts nominal units in one structure
111 Multi - family ❑Master builder ❑Other: ❑ Building over three stories El Feeders, 400 amps or more
sss.. t # „ _ ['Occupant load over 99 persons ['Manufactured structures or
i ' . L JO =SITE N FORMAtI ION D ,OCAT ON r ❑E gress /lighting plan RV park
Job no.: Job site address: 9095 �` ❑Health -care facility ❑Other:
) l ��.t I `A`M Sr Submit 2 sets of plans with any of the above.
City /State /ZIP: -- ri 6 612- 9 3 The above are not applicable to temporary construction service
Suite/bldg. /apt. no.: Project name: : _ Z-94 FEE SCHEDULE . ,- * }
r:.�.
Description Qty. Fee. Total
Cross street/directions to job site: J t LbI A) 0 ),T `F fi New residential single - or multi - family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
�-
�� � Limited energy, non-residential 75.00 2
:� k _ , -. n_s, ?��. - o,Ix wolirc �� _ ,
Each manufactured or modular
dwelling, service and /or feeder 90.90 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
ii � � x �:. � � � � E � � 201 amps to 400 amps 106.85 2
, PROPER O WN ER e, , , ki , . � n TE NAN T , - 401 amps to 600 amps 160.60 2
Name: e060 G; S'4T- 601 amps to 1,000 amps 240.60 2
Address: C 3 4 395 5l.k) aagAii -/,itai Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City /State /ZIP: '7 b D-e._ 9 7 '7/23 Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) Fax: ( )
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 amps to 600 amps 133 75 2
-Owner signature: Date: Branch circuits — new, alteration, or extension, per panel
i. i �°� ' . i - `" 'f ` �.v A. Fee for branch circuits with
gi .. Y APPL $.. :, . . _ _ CONTA PE . a r
service or feeder fee, each 6.65 2
Business name: branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee,
each branch circuit 46.85 2
Address:
Each addl branch circuit Jp 6.65 66 , 50 2
•
City /State /ZIP: Miscellaneous (service or feeder not included)
Phone: ( ) Fax:: ( ) Pump or irrigation circle 53.40 2
Sign or outline lighting 53.40 2
E - mail: Signal circuit(s) or limited -
M ... r l i GONTRAC1 12� 1 fr � � t energy panel, alteration, or
�.` .' �.' ,_ .o- �' �� �.a .x � x��.. <:. extension. Describe: Page 2 75 2
Business name: Cp. Ej20/J 74())144 (- C.
Address: - 0 - '32.,‘—( Each additional inspection over allowable in any of the above
Per inspection 62.50
City /State /ZIP: ACS 0 A U'2 970c)(- Investigation per hour (1 hr min) 62.50
Phone: (5? 6 29 89 33' �` Fax: (5D3) 6 Z 9 G1 68 Industrial plant per hour 73.75
E ; ; 4, ,EI EC'I4c74 1-.0 , FEE :Wit r , j am
CCB Lie.: , 32773 Electrical Lie.: 3 n _ SZ__6L / Suprv. Lie.: ' 3S Subtotal
Suprv. Electrician signature, required: ` L c _ Plan review (25% of permit fee) —7, 3
!
Print Date: name �� State surcharge (8% of permit fee
1261//Al "r " — �� TOTAL PERMIT FEE
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete 15 233,8.'
Print name: Date: * Fee methodology set by Tri- County Building Industry Service Board
** Number of inspections per permit allowed.
i:\Building\Permits\ELC- PermitApp.doc 12/03 440- 4615T( I 0 /02JCOMIWEB
Electrical Permit Application - City of Tigard °� `�
Page 2 - Supplemental Information \v1
LIMITED ENERGY PERMIT FEES: �' L
MAW RO vita
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
❑ Other:
Fee for each commercial system $75.00 •
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
--Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
'® OtherV
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
\ Building 'Perntits\ELC- PermitApp.doc 04/03
C ITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2003 -00704
DEVELOPMENT SERVICES DATE ISSUED: 12/5/03
A 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S 102AD -01300
SITE ADDRESS: 09095 SW BURNHAM ST
ZONING: CBD
SUBDIVISION:
BLOCK: LOT : JURISDICTION: TIG
Project Description: Install 13 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: 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: 12 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:
WYATT, DEWEY CAMERON THOMAS LLC
c/o WYATT, EUGENE P.O. BOX 5324
9095 SW BURNHAM ALOHA, OR 97006
TIGARD, OR 97223
Phone: Phone: 503 - 629 -8938
Reg #: LIC 138773
ELE 34 -526C
FEES SUP 4633S
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 12/5/03 $126.65
[TAX] 8% State Surcharge 12/5/03 $10.13 Rough -
Elect'I Final
Total $136.78
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. / n /
Issued B y: Jo lad J Permit Signature .
u 1 .
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: `'i 3
Call 639 -4175 by 7:00pm for an inspection the next business day
•
12 , 0 ;::: ,' 0 3 TUE' 12 : 33 FAX 5 O3 24 5 2 2 9 S 1-• 3
v_Vlit'VERGREEN l'AC1F.
-4-3 -4 CAMERON TI-10M 2VS?; . •
ra• 002
. _ . .
•
, • re , ,,„!... ,.. ,
• WitininiailMKOWSO-OEF;;: -, : AVityagentrt#
-Electrical Permit Application. I Received , ,,,, Electrical r ---
Date/By: (: li7 0 l'eirnit -067 0
. .
CAN' of Tio-ard Planning Approval Siam
•:e) • . Date/By: : Permit No."
13 I 25 SW Hail Blvd. is\ I Plan Review • __. _____
Other
■-■ • ;/ ------
TIgo.KI:1, 01 9'7'22.2 \ [ Dateipy::
Phon.e: 5i... 1. 7 1 Fax: 503-59C- I. 9 6 0 1 Post-Review :: Land lise
I
..`.!:',.. ,_Datei'Ey: ___1_ Case f\124_
littet.11e.t: v[vtrx.Ci.ti0.:arlo:r.us _0 1 • -' , 1 . ' (11 ---- A
, ':.-_ • ' '11 !' v . I Contact I Juri - 2 for
: I 0 See Page
24 - h OUT 'lisp ti on Request: 503-639-4 1 7 5 .----"`-"'"'-.*- i '''' L Name/Method: I
..4
Supplemental Information.,
11 RAMPT4 ) -4W 3 0 4- 4 9 :1 1 0 6 ;11R7 - 4 - 4 , -17 it-7 17 :4: 31: re.W01-07 r ag - W-V - T.A . . - .00Watagilijitaitilliff,M...7. t i --- ;: - W
_
.1 New construction L,1 Demolition i 0 Service over 225 amps- 0 Hea ar
lth-ce facility
1 '-1
1 L17 . * I ' er t • . 1 * '' 1 - + c-) ' • --- commercial
. I.. t ., tr. ..
a ion ! f L at.. eft11t i.t., f , _ .. _ _ _ _ ; 0 s , 360 amps of 0 Hazardous location
TD
0 Building over 10,000 square fect,
10, - .Pg j :OiZkieWill'i3O41 - 40 - ffiriP317SIKI r tki1571 7 “0 - PT:ni . 1 "-- .;i 1 4 - ' , 1 t_3(.. 2 fan dwellings - four or more t UZI; t-S it
1 _ l'.' ,,, - ..' - --• -' - - - -- - -,,Le. .......:-, .......:,...,,,,-- , -,14,-..ti..,-,'rx:-La.-.-- , -,. , 2_::4 _
L i i & 2-1 arm LV dwelling i41 Commercialandustria 1
vo_ 1 Li SYstcm over 600 ts nominal one structure
I-- r..-:" .• 1 0 Building over three stories 0 Feeders, 400 an or more
i LI keeessory Flui kin a Mut
[ - li-Familv -- -
0 Occupant load over 99 persons 0 Manufactured structures or RV park
. i Master Builder I D Other: I ,,__Ir" Egessilighting. plan 0 Other:
fi*Wilinf.:11T-f!';',F07.f,Wgi talikli4S I Submit _ sets of plans with any of the above,
The ve are to terupoLail_cciL_Istruction service, , _
_______1 . ." W-4 above
_ 1). _es_c5 : : :V'EV B. ZT4 , ittria'it•., ._•, 17"...tk.„,...r111111-,,,,p,,,trizt,:iie`""4=-4,4.W.-t-iirt-t-,--Y4Wate'l"Trallill'i
I Job site a.dclress: c.,4 -"-.. 4: '
Suite #:
[ ..,i10-- 1 Blds./Apt.#: ..4._ r
Number of i
i , nspections peLp_erruit allowed
*I P1:0 ,k,' ,i-0.7,--/ 74 , 1 , 4)2 0.i . _ I Qty Fee fea.) Total IL
16 resideutiat-single 6r multi-family per 4
Cro;ss strect.:Directions to job site: dwelling unit. Includes attached garage.
1
Service included: 1
7. 1:7.,.._i A//r 1000 s . ft. or less 1 145.15 4
I Ert•ch additional 500 sq._ ft. or portion thereof 1 ----- __
1-- 1 Li
j. - ; --_- - . _ ,e, -I- -, .O9 1-1
1 _,. t 1 ,.. „c .._mjytcl eriLtresitatentla_l _. ,J. 2
l_. . __/ _______i___.- ''..d F Llinited energy 1
, non restdential i .0t..: j _
• I i
' .. • • • '
1 Tax . - " i l'
1 t ax. map p_,Irc.: . _ ____0,,,,,±.____ _ _ _ _____ .. , act' manufactured home. or modular dwelling i
,4 J"1447igYT:PdPATIffitiIiikWIAWT47-4.11t:inLiiicim431 i .ervice 3nd;or feeder .90.90 I 2 I
.
r ----- " ""-----"'-'-""----- ' ' '''''' ° - '''''''''' Servic.7s or feeders - hastailation, I --- I 1
-.,,,e,,,-„, _. ,..
,., . _ ,,,,,a,- alteration or relocation:
'
r
I 1
/ -- 1 200 amos or less 80.30 1 1 2
j____
/1: • .i)e. //../ .. 74 .,/ -3
- / 7 ----- 1, 2 91 amos - ici AGO amps
1 01 am_ps to 600 amps r 1 160.60 +._
. _ _.
Otiiiialiare,',03 Lj9 aln2s t° ICK- ania t ---- 1 --- 7?A707(7)5 2
,, _
,, X . V - ......:1.....LV.I.-44:."FL I ov , _ , coo .,,. __ J ___
a i. 1 ---- '
i or 454..65 2 '
Reconnect only , 66.85 4
. ,_
I • •'--- .:
Address : 47 1/ I S - ' ::.) z ed,. s--v.:.--- i - Temporar rvi
y seces or feeders - installation,
7 i
mterad,....„ or relocation:
ClIy/S Ia.I ip: 200 amos or less 66.85 1
Phone: 4, ---3 I Fax: ,,Q4.7- 20t amps to 400 amps
'.*** 7-1"X" h-. - 7r , .• - ewz - t.7., -- ---,-;,, - -r - t ,-- -- ---- .6 ,, , t„-,----:---,. -6;a7Tottr.. 401 to 600 amps __a__ _ 1 .__2: 36 __t_ 2 I
133.75 -
Xti ii, • - - ---- --
c rirctuts - new. a it erotic's', or
Nam?' _-yre.. extension per panel: ,
- A. Fee for branch_ circuits with purchase of
1
f A.d.dress iic. • '' ' -
-64 _LXec&-- <entice or feeder fee, each branch circuit 6.65 - 1_2 ,
...
[ qty/S..tatei4ipl_ tf,? / ,," 69:4" 1 - ,r t ",./-,„ (27..r74(., B. Fee for branch circuits without purchase of ' A
- 1 ranch service Gr feeder fee, fust cuit blanch circuit 46 4 I
i ITIQA_Vp
---1
' . Plionr.: 4 -'' ' 7 i- --- 4- 6 2 6.t 1 " F a y: 67 •36 -- z',,i-
• , - -.i.p.,,,.-- - - .,, ...____..:_-• •,-- . ,.., Each additional b cir 1'2_ 6. 1 --- 2 j
- -1-4.
E-1Tlai1: 4 1/4.- 1 Misc.(Service or feeder not included):
l.7:2'd Each Lump or irrigation circle r _ 1 _ _.5 04 __1.__ _
'tii. . --''sli i .- ,r. -,- . - ..
job No:
11 Signal circuit(s) or a limited energy panel, /
_ 53.4
1------------- 1 aheranon or eine-mien P2112: _
' Business Naine:C4/40 _____, 1 DescripdOr„ . '
Address: ft E30 r-j32..4 1 tr
- Filch ch additional inspection over the allowable Sn any of the above:
I -Cii \r/StaWZ CI 1 -- --0 _ 1 ..,.. OR- 1/4- /C .___ 1 hour) ---
1 ,s Z____
.,_ -, .1-
I i'D-1:101e'
- - 3.1FI:L::7_._-_9_5_.1 ob H 1- Investigation fee:
I CCB I- # 77 . I 5 3
__...._......._,____ _ ___
"
„ ur2ervistrig e
en ,.,,,, -- - - - / --- I ,, -- y ._ Subto
7 - i - ; .4 - F - - t'''''''': ..,--,- - ..".,..1.
\ f 1 0 --- ,. tl S j "L t (elV
‘----------------;_,
sil_galati reciutre ,,:____ __ _ _ 1 . Plan R.eview (25% of Permit Fee) I 1:
Print Name' /2& CP_D I LiC ili' I 03 - 1 - State Sun (R% tpcP•-rrnit Pe‘-' 1; TOT k -7 0 .------ 1
-
\ Authorized , Z-7 I/ / / i TOTAL PERMIT FEE1S _..._. I
Notice.; This permit application expire-is if .1 permit is uat obtained viittin
4 / •
S ign irt u r e : - ,-- 7 --- Date: ''/,‘:-, ., --' 1130 days after it has been accepted as complete. '
/
- - --7 - --
1 / "Fee methodology set by Tri-County Building Tndustr3 Service Beard.
a ' ,/ -- • ( - 1'- ‘ -? ' 9 W" --- Al,k-j-
_
(Please prin name)
i:' Forms\ ElacrmitApp doe 01/03 /
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received r —Date Re nested 3 # AM PM BUP
Location � � 9,5
i, > Suite MEC
Contact Person Ph ( �v J) PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner — 07) �� r 0 ?�
Footing
Foundation Access: ELC
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other: C
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In 147
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
PASS PART F
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
•m
Fin Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
S PART FAIL
SITE Please call for reinspection RE: 0 Unable to inspect — no access
Fire Supply Line
ADA Approach/Sidewalk Dat '� � Inspector
Other:
Final DO NOT REMOVE this inspection recor r om th ob si Ext
site.
PASS PART FAIL