Permit I
CITY OF TIGARD ELECTRICAL PERMIT
' ; r PERMIT #: ELC2004 -00264
ICI
DEVELOPMENT SERVICES DATE ISSUED: 5/14/2004
-'-` 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S 102AD -02400
SITE ADDRESS: 08950 SW BURNHAM ST 100
SUBDIVISION: BURNHAM TRACTS ZONING: CBD
BLOCK: LOT : 005 JURISDICTION: TIG
Project Description: Service for kiosk.
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: 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:
NW PREFERRED FEDERAL CREDIT UNION E C COMPANY
13333 SW 68TH PARKWAY PO BOX 10286
TIGARD, OR 97223 PORTLAND, OR 97296
Phone: 503- 403 -6210 Phone: 503 - 552 -5503
Reg #: ELE 26 -45C
LIC 49737
FEES SUP 4040S
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 5/14/2004 $80.30
[TAX] 8% State Surcharge 5/14/2004 $6.42 Elect'I Service
Rough -in
Total $86.72 Elect'I 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 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 -33 344.
Issued By: 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:
Call 639 -4175 by 7:00pm for an inspection the next business day
05/12/2004 22: 46 5 U l c i v E • PAGE 02
. Electrical Permit Application i FOR OFFICE USE ONLY
` / Electrical
., NAY 1 c� LUU t �•
DateJB : /1 ! * Permit No (C— o(1.Zio T
City of 'Tigard CITY OF TIGARD Planning • .prov-1
Date/By: Sign Permit No, :
13125 SW Hall Baud_ BUILDING DIVISION Plan n Review other
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503 - 639 -4171 Fax: 503 -598 -1960 Post Review Land Use
L ,. ,, 't\ Date/B
Internet: www.ci.ti:gard_or.us I 'I 1 _- Case No.: _
24-hour Inspection Request: 503-639-4175 n Contact Axis.: Name/Methpd:
/0 I - 0 See Page 2 for
Supplemental Information.
TYPE OF WORK PLAN REVIEW Please check all that a t ,1
New construction Demolition ■ Service over 225 amps- ■ Health -care facility
Addition/alteration/replacement Other: commercial ❑ Hazardous location
.: CATEGORY OF CONSTRUCTION — ❑ Service over 320 amps -rating of ❑ Building over 10,000 square feet,
_ 1 & 2 family dwellings four or more residential units in
• 1 & 2 -Famil dwellin ComxnercialAndustriai 0 System over 600 volts nominal one structure
111 ACCe5S0 BuilditA Multi -k atllil CI Building over three stories 1:1 Feeders, 400 amps or more
❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
• Master Builder n Other ❑ Egress /lighting plan ❑ Other:
JOB SITE INFORMATION and LOCATION Submit sets of plans with any of the above,
Job site address: Qc\S o V (Sti.rr S 1. The above arc not applicable to temporary construction service.
~� `� FEE* SCITIEDULE
Suite #: I Bldg. /Apt. #: Number of ins ections per permit allowed
Project Name: N<...) Pte C. I 4 C..1, AA Us,. , p Description Qty Pee (ea.) I 'T
Cross street/Directions to job site: Yew tesidantlat stagte pr multi - family per i}
dwelling unit. Includes attached garage.
Service Included;
1000 sq. ft. or less 145.15
Each additional 500 sq. ft. or portion thereof 33.40 I
Subdivision: Limited enemy, residential 75.00 ,
Lot #' Limited enerr.non residential 75.00
Tax map /parcel #: Each manufactured home or modular dwelling
DESCRIPTION OF WORK service and/or feeder 90.90
\b D rvices or feeders - installation,
Nz'•'�sp o Sr S'r we c� �� cr-\ k � O.S ' alteration or relocation: n p
200 amps or less \ 80 "30 QUJ 2
201 amps to 400 amps 106,85 2
401 amps to 600 ergs 160.60 2
• 0 PROPERTY OWNER • 1' 0 TENANT .. 601 amps to 1000 amps 240.60 _ 2
Name:
Over 1000 am .5 or volts 454.65 2
Reconnect only 66,85 2
Address: Temporary services or feeders - installation,
City/State/Zip: alteration, or relocation:
200 amps or less 66.85 I
Phone: [Fax:
201 amps to 400 ams 00.30 2
APPLICANT 0 CONTACT PERSON 401 to 600 amps 133.75 2
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
'-- service or feeder fee, first branch circuit 46.85 2
Phone: Fax: Each additional branch circuit 6.65 2
E -mail: Misc.(Service or feeder not included):
Each .um. or irritation circle 53.40 2
_ CONTRACTOR Each sign or outline lighting 53.40 2
Job No: 'r1 \ 1S % • signal circuit(s) or a limited energy panel,
Business Name: C lteration, or extension Page 2 2
Co Cw ( , ,'' l Description:
Address: P 0 db \o �t L
CI /State/Zip: p 4 oY1 1 Each additional inspection over the allowable in any of the above:
ty \ L1 Per inspection per hour (min. I hour) _ _ 62.50
Phone: `.') 0 - S`V "fl Fax: ''a - Nu \I., Investigation fee:
CCB Lie. #: �- Other
�• -� Electrical Permlt'fees'
Supervising elec Rxc t , Subtotal $ S U. 3 0
sit ature re.uired: r;�;j A 14 Art � Plan review (25% of Permit Fee) $
Print Name; `r I y I�� State Surcharge (S% of Permit Fee) S (00 .a
TOTAL PERMIT FEE S $G.71D-
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\Fermit Forms \ ElcPermi tApp.doc 01/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: 4503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 - 4171 MST
BUP
Received Date Requested AM PM BUP
Location O 5 G�f'l'1 Suite- / err MEC
Contact Person Ph ( ) € — / (OO p PLM
Contractor / Ph ( ) SWR
BUILDING Tenant/Owner /J w ELC 0206 <- 1 - C- 11 -‘
Footing ((U11
Foundation ELC
Access:
Ftg Drain • ELR -
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath /Shear
Int Sheath/Shear -
Framing
Insulationp,�
Drywall Nailing
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 V
•
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
ervic
ough -In ,}
UG /Slab
Low Voltage .�---
Fire Alarm
PART FAIL
Li Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SI Li Please call for reinspection RE: El Unable to inspect — no access
Fire Supply Line
ADA ran
Approach/Sidewalk Date 1 Inspector 1 U M�u�''� Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL