Permit C ITY O F 1 I GLAD ELECTRICAL PERMIT
PERMIT #: ELC2003 -00686
DEVELOPMENT SERVICES DATE ISSUED: 11/20/03
13125 SW Hall Blvd., Tigard. OR 97223 (503) 639 -4171 PARCEL: 1 S126DC 04400
SITE ADDRESS: 09430 SW CORAL ST 150
SUBDIVISION: LEHMANN ACRE TRACT ZONING: C -P
BLOCK: LOT : 007 JURISDICTION: TIG
Project Description: Electrical tenant improvement, (1) 200 amp or less panel and (6) branch circuits.
Job No. 18973
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: f
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: 6 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:
RENAISSANCE DEVELOPMENT THREE PHASE ELECTRIC
1672 SW WILLAMETTE FALLS DR. 8960 S. BLACK BEAR
CANBY, OR 97013
Phone: 503 - 557 -8000 Phone: 503 - 263 -2558
Reg #: ELE 24 -390C
LIC 128282
FEES SUP 4498S
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 11/20/03 $120.20
[TAX] 8% State Surcharge 11/20/03 $9.62 Elect'I Service
Rough -in
Total $129.82 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 b- :. e in .cso dance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended
for mo - than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set
fort in OAR 952 - 001 -0010 through OAR _- 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503) 246 -6699 or
1 -:00- 332 -2344. 1 _
I. sued By: �► � AC6a4
Permit Signature: jd0, 'ICJ /
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: /'r " i DATE:
LICENSE NO:
Call 639 -4175 by 7:00pm for an inspection the next business day
11/19/2003 15:19 503 - 651 -3540 THREE PHASE ELECTRIC PAGE 02
EXectr Received , Electrica]
Date/lly: It / 9 0&- 1.41 Permit PeruitNo.:eze 5- � C e Vr o
City of Tigard RECEIVED Planning Approve} Sign
Date/13Y: Perrnit No.:
13125 SW Hall Blvd. Plan Review Other Tigard, Oregon 97223 n JU 1 9 2003 I}ate/kI Pct it No.
Phone: 503 - 639 -4171 Fax: 5 ., -598 -1964 Post Review Land Use
k, R•, . h 7 t> a
Internet www_e1.tagard.or,us CITY OF TIGA " ip �, Co ; Case xo_:
!u P. :5 sea Page 2 for
.24—hour Inspection. Request: 7[�IVI'""� Name/Method: • SupplementalInfortrintion.
,'") . • • ..., ::. 4!YPE' OF. WORK .: , . .: , PLAN'k VIE b ., .. fib . .
W X�e c ec >3 s � ply ',
II New construction C Demolition 0 Service over 225 amps- Bealth.eare facility
I�I commercial ❑ Hazardous location
I
I Addition/alteration/r- • lacement L Other: ❑ Service over 320 amps-rating of ❑ Building over 10,000 square feet,
:CATS ' •RY Or. CONSTRUCTION 1 & 2 family dwellings four or more residential units in
IU 1 & 2- Family dwelling 1- CamR2ercialfindustrial ❑ System over 600 volts nominal one structure
ACCe6
III
50 BUlldltl: n Multi-Fan-ill l~OTTfiI ❑ Building over three stories ❑ Feeders, 400 amps or mote
Builder ❑ Occupant load over 99 persons El Mgnufactured structures or RV park
• A
,� Other: 0 Egress/lighting plao [] Other
J OB,S rit t ... S ubmit sets of plans with any ._ .. . ,• � Q ' TIOlK.:and��QGe#1'XON :.: ;:. ,,;', p of the above.
p The above are not a licable to tern t construction service.
Job site address: { J r I .
Suite #: BId ./A t_ #: Number of inspections per permit allowed
1 §g its•: m' .: _ r.: r; :� ` yi.:, .: :;
Suite #:
1)cs tlOO
B 1 . tit T p Qty Fee (ea_) 'rotas i
Cross street/Directions to job site: New residential-single or multi-family per
dwelling unit. Includes attached garage.
5 t/J . ` Service incinded:
Y 1,000 sq. ft. or less 145.15 4
Each additional 500 sq. ft or portion thereof 33,40 1
Subdivision: Lot #: Limited eoeTkresidential 75.00 2
Limited energy, non residential 75.00 2
Tax map/parcel #: Each manufactured home or modular dwelling
DFiSCRIP'I'ION :OF WOE service and/or fccdcr 90.90 2
' Services or feeders - iostalladon,
/• + • 0 • IwR. , _ alteration or relocation: Q
! 7 ti • ._ K E • (\ O 200 stops or less I 80,30 ( ,O --' 2
201 amps to 400 amps — Ps aw 106,85 2
�I ! .
401 amps to 600 amps 160.60 2
' ® :IPR:Ok, :. ' ' TY OWNER 1 '' ■ :TENANT' 601 amps to 1000 amps 240.60 2
Name: Over 1000 amps or volts 454.65 2
Reconnect only 66.85 2
Address: Temporary services or feeders- Instatllation,
alteratioo, Or relocation:
City /State/Zip: 200 amps or lcsa 66.85 t
Phone: Fax: 401 am to 410 amps 100.30 2
II .'4 'l[ c1 N"C' `" ` :. .: n :: ,y'<:. QI� ' I iN AC`I 1sEIESO 401 to 600 am.,s 133,75 2 • Name: Branch circutta- new, alteration, or
extension per panel:
Address: A. Fee for branch circuits with purchase of f q g t7
service or feeder fee, each branch circuit 6 6.65 3 4 ^ 2
Ci /State/2i+ : B. Fee for branch circuits without purchase of
service or feeder fee, fast branch circuit 46.85 2
Phone: Fax: Each additional branch circuit 6.65 2
E-mail: Misc.(Serviee Or feeder not included):
Each pump or irrigatiocircle 53.40 2
`; Each sign or outline li ri 53.40 2
Job No: -, 't signal eirettil(s) or a limited energy panel,
�
alteration, or extension
Business Name: .-- A L • L.. ��.7tr.
tFCfi ....__ PaAe2 2
�»LIOrI
Address. -1 �� � i} , � .
Each additional inspection over the allowable in any of the above:
IIIMETZM a � � , Par iniceetiun per hoot . 1 hour) 62.50 '
Phone: -- Z 111 r r Investigation fee:
CCB Lic. #: I : �;:�� `_ - O ther:
Supervising electrician / . Ei ' •cat,F'ihriui'1F ' „',le, :,
,''''''; 'r • si • , attire re • uired: - A.„._ a _ ..j mit Fe
s) $ e a$
'.
- � ' l� � 1,. Pl an. Review (25% of E'
t 1 ame; i li, a k r MEI: UM. State Surcharge (8% of Permit Fee) - $ � `/ C9 2 -
TOTAL rauurr FETE $ 1 7_ S ,Z-
Authorized Notice: This permit application expires Wit permit is not obtel ed wltblit
Signature_ Date: X80 days after it•baa been accepted as complete.
*Fee methodology set.by Tri -County Building Industry Service Board_
(Please print name) -
i: \Dsta\Permit Form\ Eicl'crmitApp.doc 01/03
T"d dT5t80 Ed 6T 1N01.1
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 .
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested P. . b AM PM. BUP
Location _ I MEC
Contact Person Ph ( PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC 0
Footing ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath /Shear
Int Sheath /Shear •
Framing
Insulation C. I
Drywall Nailing
Firewall
Fire Sprinkler 1 ;. •
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
MECHANICAL
Post•& Beam
Rough -In
Gas Line
Smoke Dampers
Final
PART- FAIL
EC. °RIC
Service
Rough -In
L olt
�-7) , /
Low Voltage � //
Alarm
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
SITE Please call for reinspe tion RE: ❑ Unable to inspect - no access
Fire Supply Line
ADA /
Approach/Sidewalk Date Inspect. Ext
Other:
Final DO NOT REMOVE this inspection record from th ob site.
PASS PART FAIL