Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00430
, DEVELOPMENT SERVICES DATE ISSUED: 7/16/2004
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S102DA -00401
SITE ADDRESS: 13125 SW HALL BLVD
SUBDIVISION: ZONING. CBD
BLOCK: LOT : JURISDICTION: TIG
Project Description: Disconnect lights and outlets for shelves.
Job # 72004
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: 1 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:
TIGARD, CITY OF OREGON ELECTRIC CONST /GROUP
13125 SW HALL 1010 SE 11TH AVE
TIGARD, OR 97223 PORTLAND, OR 97214
Phone: Phone: 503 - 234 - 9900
Reg #: LIC 203
SUP 4460S
FEES ELE 26 -95C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 7/16/2004 $53.50
[TAX] 8% State Surcharge 7/16/2004 $4 Rough -in
Elect'I Final
Total $57,78
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 1-800-332-23
Issued By: ) Permit Signature: ,, )-Ci
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
•
JUL -13 -04 09:08AM FROM — Oregon Electric Estimating 5032313587 T-821 P.001 /002 F -796
Elea ricaYPermit Application /-' ! '
Received
'City of Tigard {�
i 7 � O S / fn P it No.; 6 L C J0V - 0'0 Y3 0
�' Ry:
Plan J li1 ` '
13125 SW Hail Blvd., Tigard, OR 97223 Plan Review Oilier Permit:
Phone: 503.639.4171 Fax: 503.598,1960 0s ! 4 ■ `,,t`g,t,4 Dale /B - --
■ ` !! I Date lee /Mcth
Notified/McdtoJ; t el Sec Pe For
Inspection Line: 503.639.4175 "i' 1 (T Supplemental l Information
^
Internet: www.ci.tigard.or.us 1 Lo
' • TYPE tOY W oli . . • : PLAN , REVIEW
' Please check all that apply:
El New construction pp y•
® Ad d iti on/alt Nl 0 t n(y \I �ment ❑Service over 225 amps, cornm'1 Ql4azardous location
0 Demolition 0 Other: CATEGORY; 0 (-.*C „ ..- ['Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
�' ” of 1- and 2- family dwellings 4 or more new residential • ,x,;\
STRUCTIOT
OSystem over 600 volts nominal units in one structure
❑ 1- and 2-family dwelling Commercial /industrial [] Accessory building ❑Building over three stories ❑Feeders, 400 amps or more
❑ Multi- family ❑ Master builder ❑ Oiher. ❑Occupant load over 99 persons ❑Manufactured structures or
park
JOE SITE 1N'yORMAfION • AliD.,LOCATIOT : ' • ❑ggress/lighring plan RV ❑R1hpa
pa
LJHealih -eare facility • Job no.: 72004 Job site address: 13125 SW Hall Blvd Submit 2 sets of plans with any of the above.
City /State /ZiP: Tigard, OR 97233 _ The above are not applicable to temporary construction service
FEE SCHEDULE
Suite/bldg. /apt. no.: Project name: Tigard - kubWlc - bilt>»ly ne3CrlptlOn l Qty. I Fee. Thal `"
Cross street/directions to job site: 1' C �2 � � N ew residential single- or multi- family dwelling unit
includes attached garage.
1,000 sq. ft, or less 145 - , 4
Lot no.: Ea. add'] 500 sq. ft. or portion 33.40 1
S ubdivision:_ Limited energy, residential 75.00 2 -
Tax map /parcel no.. Limited energy, non- residential 75.00 2
DESCRIPTION OF 'WORK .. l=ath manufactured or modular
dwelling, service and/or feeder 90.90 2
Disconnect Lights and outlets for shelves. Services or feeders installation, alteration, and/or relocation
200 amps ar less 80.30 2 1
201 amps to 400 amps 106.85 2 '
• ❑ PROPERTY: OWNER '" • • • ❑ ; RNANT 401 amps to 600 amps 160.60 2 -
Name: Tigard Public Library 601 amps to 1,000 amps ` 240.60 2 -
Address: 13125 SW Hall Blvd. Over 1,000 amps or volts 454,65 2
Reconnect only 66.85 2
City /Slate /ZIP: Tigard, OR 97223 - - Temporary services or feeders installation, alteration, and/or
relocation
Phone: (502)887-1188 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
APPLICANT i ' ' -' 1=1 COWL. C'li'p PERSON, • A. Feb for branch circuits with
Q - • service or feeder fee, each 6.65 2
Business name: branch circuit
B. Fee for branch circuits
Contact name: wirhout service or feeder fee, / 46.85 1 4.1) 4C- 2
each branch circuit
Address: Each add'] branch circuit 6.65 6--G " 2
City /State/ZIP: _ Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: ( ) 1 Fax: ( ) Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited-
' - . CONTRACTOR: .. .. energy panel, alteration, or
l extension, Describe: Page 2 2 •
Business name: Oregon Electric Group . —
Each additional Inspection over allowable in any of the above
Address: 1010 SE 11th Ave per inspection 62.50
City /State/ZIP: Portland, OR 97214 Investigation per hour (1 hr min) 62.50
Phone: (503) 535-2652 [ax: (503) 231 -3587 Industrial plant per hour 73.75
ELECTRICAL • PERMIT FEES*
CC5 tic.; 203 Electrica .' • '6 5C Suprv, Lie.: 4460S Subtotal 7 - S ---- ,SU
Suprv. EIectrician signature, required. ' r Plan review (25% of permit fee) _
Print name: /�/ (-,/ Dat (/
d State surcharge (8% of Permit fee) 2 P
/
TOTAL PERMIT FEE S /
Authorized signature: .. L/ This permit application expires If a permit is not obtained wi
tilln 180
_ J J / days after It hn; been accepted m complete
Print name: y4�. f/ 7 - 4e/h /z-/ Date: j � �/ 4. ' Fee methodology set by Tri- County Building Industry Service Board
1 J •• Number of inspections per permit allowed.
j t iildi ,g\Permiu\ELC•Pcrmitnpp•dec 17/05 440.46I ST( io1azCOMhv3D
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
y = BUP
Received 3/ Date Requested / AM PM BUP
Location / 3/ �� /`� Suite MEC
Contact Person Ph ( ) PLM
Contractor ; , /Y� Ph ( ) � '9 '" a SWR c�
BUILDING Ten••/%�Owner ELC a 7 `O� �d
Footing
Foundation ELC
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
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 C ‘--C" 6 4 ., 0 2- '� - . % 64//41/Ak E S
PAS ART FAIL
- c> 03 2 -
Service
Rough -In L L af - 0
UG /Slab
Low Voltage
Fire_Alarm
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
(AS PART FAIL
SITE . 0 Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA /. / °
Approach /Sidewalk Date Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL
•