Permit 4 CITY OF TI CARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00580
�ll DEVELOPMENT SERVICES DATE ISSUED: 9/15/2004
'---' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S 110 D C -02400
SITE ADDRESS: 11565 SW DURHAM RD 110
SUBDIVISION: SDR1999 -00022 WILLOWBROOK II ZONING. C -G
BLOCK: LOT : JURISDICTION: TIG
Project Description: (4) branch circuits for new tenant space.
Job No. 10794
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:
MOODY HOLDINGS COHO ELECTRIC INC
5701 NE 105TH # D PO BOX 40
PORTLAND, OR 97213 WILSONVILLE, OR 97070
Phone: 503- 860 -0235 Phone: 503- 582 -9774
Reg #: LIC 157169
ELE 3 -575C
FEES SUP 3483S
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 9/15/2004 $66.80
[TAX] 8% State Surcharge 9/15/2004 $5.35 Rough -in
Elect'I Final
Total $72.15
•
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 ' 952 -001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -669! or 1-800-332-23
Issu-d By: *r ' Permit Signature: "may /.7,ze�'
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: _! .",71,r re — DATE:
LICENSE NO:
Call 639 -4175 by 7:00pm for an inspection the next business day
Aug 26 04 12:50p p,Z
4 Electrical Permit A►pplicafEOn
FOR OFFICE IJS>E ONLY
C itY cit _ Tigard \4 M Received n
13125 SW Hall Blvd„ Tigard, O Ducal - if Aga- ; � Pentut N ea,. � .,, 66 s i t
5 �oo .,i k Plan
Phone: 503.639 -4171 Fax, 03 V�J
Inspection Line: 503.639,4 r L Date bs Z„ - Other Permit. • Interact: www h.tigard,or.us V • heady /BV 7u tp ® lee Page 2 for
n \® \ �v - ,e y �� 6
Notified/Method
atwo � 6 1 I� h ` .,tGr �\ Upptemcetal information
?A?m' K)fiUwi - ` � ; .i S 1i . � °t i, +i rt ;5iv'li ' s^'r- a' , °, � S
It ,,, ,< C',„ E,, „ , r ir,.�.t,, %.< , , .' w i '- •" ... i r
El New construction ." 1 ; ` t Mrr'.1k7
21 6ai 5 Please check all that apply —
❑ Demolition CD 00- ❑Service over 225
amps, comm.! O1lazardnus
1� g� , location
u l,. !?i N « r t u r Z cylt u i : '' ❑Service over amps - rating ❑Bulldog over 10,000 s
i " °'` 3 . acv "' "' t pry '" 11 x :u' ' 1" of I - and 2 - famimill y dwellings 4 or more new residential
El 1- 1- and 2- family dwelling Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑ Multi family ❑ Master builder Other; ❑Building over three stones DPccders, 400 amps or more
t r J? fa � j Ma . i M � ) ' . M1 • i1 5 h v s ;IP p ll �(y 4t,,�c�� p , , � , iz t ❑ Occupant l over 99 persons ❑Manufactured Structures or
s .�1$$ . i ` aunt - � tSZ #all`s ` ,6 ❑ Lgeas/liEh angplan RV park
Job no.: 1 \1/41.4 Job site address; ❑h ealth - care facility
tt 5b5 51r. �� -6,�, Rct ry ❑Otl,or:
City /Statc/LIp; -� Submit sets of plans with any of the above,
r` 4 0:2.5. --- O a.at } The above are not applicable to temporary
Suite/bldg./apt, / n - temporary construction service, 8 Apt nn.: O P roject nantc: C , l • � i °4 , ' , ' a �t t• r t. ` -_ --,--
• � J.•• ` ° Descrtprten
Cross strcet/dirccttons to job site; 12b Fee. TI
New residential single - or multi -family dwelling unit.
Includes attached garage.
1,000 sq. ft or less 145.15 4
Subdivision; sq. E a. add'I 500 s f t, portion omon 33.40
Lot no : 1
Tax map/parcel no Limited energy, residential 75.00 2
c Y u r Yi t„ r, i w Limited energy, non - residential
,i$1 ''�" �irar'.x �4 �''"�4�a ev 75.00
" L �ti r. '' 1 l Each manufacttared or modular -
v - 00"x, ' ... 6,....' �F Ctt„ , �� I dwelhns, service and /or feeder 90.90 2
Services or feeders installation, alteration, and/or relocation
� v r,+l 200 amps or Less 80.30
a.. )"3 Rr+kr ty , miffs tanag ;, it ' K V.? ;'-? - 2 amps - 4 00 atirips I0685 2
Name: 1�� c . „„ ; 401 01 amps to 600 amps 160.60 2
601 amps [0 1,000 amps 240,60
Address: \, 5 ( c "
> `6 . di Over 1 amp or v olts 454
54 ri5 2
City/State/ZIP: " ' Reconnect only 66 85 2
` % T cA�Q.t�,, Temporary services or feeder$ installation, alteration, and/or
Phone; ( ) Fax: ( ) relocation
Owner installation: This installation is being ro crt that i own which is not 200 amps or less 66,85 1
intended for sale, lease, rent, or exchange, according to 0123 447, 449, 670, and 701. 201 amps amps to 400 amps 100 30 2 •
401 amps to 600 am 133.75 2
Owner signature: Data �� " �" � e W« 'r s= r., r q �. a r ;r ' on, per panel
r: . r� F J' ` grill :
Branch c euits - new, alteration or extension, �,� rt`a `�k p °i 4 i y ' • • �}�'J r M L f • r ` ; 4 �t> A, lee for branch Circuits with
—
( r�i� „ r�, �,��a - �t�
Business name: service or fader fee, each
branch circuit 6 - 65 2
Contact Hanle; B. Fee far branch circuits •
without service or feeder fee, _
Address: each branch circuit
46.85 1 _!1(0.7 2
City /Staid "LIP: Bach ad/VI branch circuit 3 6.65 ' i9.9, . / 2
Miscellaneous (service Or feeder not included)
Phone: (- ) I : ( Pum or in'igat cir cle
Fax: 53
E-mail; .. Sign or outline lighting 2 2
t'� w li i `r i e"va" '......'7710. r ` i t1£ � RSa. • Signal circuit(s) limi 53 0
i r u / ,': ;'l ,Pw, energy panel, slteration, or
Business name: C extension. Describe' Page 2 2
�h� F \sr. r
Address: Q
V `` c Each additional inspection over allowable in any of the above
City /$fatc/LIP `� t ,1 • Per inspection 62.0
~v • \ `• �Q ' ` d m
, ^ Investigationperhour (1hr,)) 111 62.5()
Phone: ( ) _ e _
- . 1, �� I Fax. ( ) , a� ^
Lic.. Lie.: rndustnal plant per hour 73 75
e �•
CCB IS f El ectrical ie.: , �X �' v r �;f,,,,
Lc : 1 `>
Plan review (
Suprv, Electrician signature, require 5% of permit Su it fe � , O
permit fee)
Print name:
State surcharge ($% of permit fee
_ b� - ) � . 3
r cv1 G Dat�
Authorized signature: TOTAL PERMIT FE/0 1 7, , / 5—
Print name: , ”, i Date: This permit application expires if a permit is nor obtained within -
days after It has been accepted as complete fUtin iR0
L ^ • Fee methodology set by Tri- County Building Industry Sennett Board
An aildingtrd , ❑itsL , 1,C- PemueADP.doc 17/03 "" Number of inspections per permit allowed.
440 -A6 i rr( l 0/02/COn°rwjp
CITY OF TIGARD 24 -Hour -A
BUILDING Inspection Line: (503) 639 -4175
INSPECTION - DIVISION Business (503)-639=4171 MST
s
J n BUP
G
Received Date Requested 1 AM 1 - PM BUP
Location ! / 5 0 Suite 11Z MEC
Contact Person Ph ( 6 1? `��'� PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing ELC 2 c &
Foundation Access:
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:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service `�P'
Sanitary Sewer D
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 FAIL
ELECTRICAL
Service
Rough -In
UG /Slab wd
Low Voltage G
Fire Alarm
P PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SITE _ Please call for reinsp tion RE: II Unable to inspect — no access
Fire Supply Line �� /I_Z �' ADA - Approach/Sidewalk Dat Inspector ..a Ext
Other:
Final DO NOT REMOVE this inspection record fro the Jo -site.
PASS PART FAIL