Permit \ e CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00383
ullh , DEVELOPMENT SERVICES DATE ISSUED: 6/24/2004
=-� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 1S136AD-04000
SITE ADDRESS: 11535 SW PACIFIC HWY
SUBDIVISION: VILLA RIDGE ZONING. C -G
BLOCK: LOT : 007 JURISDICTION: TIG
Project Description: 23 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: 23 PER INSPECTION:
201 - 400 amp. 1st W/O SRVC OR FDR: 0 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: >Q 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:
SMITH, EDITA M ENERGY TECHNOLOGY
833 NW 170TH DR 9801 ST. HELENS AVE.
BEAVERTON, OR 97006 VANCOUVER, WA 98664
Phone: 503 - 245 -1864 Phone: 503 - 903 -5056
Reg #: ELE 37 -863C
L1C 138643
FEES SUP 4543S
Description Date Amount Required Inspections
[ELPRMT] ELC Permit 6/24/2004 $193.15
[TAX] 8% State Surcharge 6/24/2004 $15.45 Rough -in
Elect'I Final
Total $208.60
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and - - • - - . •licable laws.
All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of ance, or if ork is
suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utili tiff - ion C •nter. Thos-
es or direct qR ins • 0 • I. 13)
246 -6699 or 1 -800- -2344. 4
Issued By: Permit Signatur • M ��
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: L el S4 3
Call 639 - 4175 by 7:00pm for an inspection the next business day
i ,.d ‘d
Electrical Permit Application FOR OFFICE USE ONLY
Ci of-Ti and P No.
hr' g Date/B AV 0 y . B ded _ —ori 3g3
13125 SW Hall Blvd., Tigard, OR 97223 Plan
/ /u . y � l l , - . Other Permit:
Phone: 503.639.4171 Fax: 503.598.1960 1 Date/B
Inspection Line: 503.639.4175 � E. Date ReadyBy: J RI See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: J - Supplemental Information
- TYPE LOF. WORK - - -PLO REVIEW . ,;r`,••
❑ New construction ❑ Addition/alteration/replacement Please check all that apply:
❑ Demolition he i A�� q _,/ $ 9-43 V E -M,E�� ['Service over 225 amps, comm'1 ❑Hazardous location
['Service over 320 amps - rating ❑Bulking over 10,000 sq. ft.,
. - GCATI%C N( Y - OF . CONSTRUCTION . _ of 1- and 2- family dwellings 4 or more new residential
❑ 1 and 2 family dwelling A Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑ Multi family ❑Master builder ❑Other: ['Building over three stories ['Feeders, 400 amps or more
['Occupant load over 99 persons OManufactured structures or
JOB SITE INFORIVIATIO}N AND LOCATION RV park
.s ❑Egre ss/lightin g plan P
VIc � Health -care facility ['Other:
Job no.: Job site address: I' 535
ubmit 2 sets of plans with any of the above.
City/State /ZIP: hit---, e l� above are not applicable to temporary construction service.
• FEE* SCHEDULE , f., -, ::' , .::' • • .
Suite/bldg. /apt. no.: Project name: A
Description I Qty. I Fee. I Total I '
Cross street/directions to job site: 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'l 500 sq. ft. or portion 33.40 l
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
• DESCRIPTION - OF WORK • _ Each manufactured or modular
- T. E.-Lit � AA) �� � dwelling, service and /or feeder 90.90 2
Services or feeders installation, alteration, and/or relocation
O 31 C..F___ a L i L tt-( 200 amps or less 80.30 2
• ❑PROPERTY OWNER . " ' ' ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: ■ I ... • e , . �� S>� � A 601 amps to 1,000 amps 240.60 2
Address: 53--(- 14 t'-1 o #7.-4..t/4.--- Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/State /ZIP: P c....Qc1CO 9,1 W ( Temporary services or feeders installation, alteration, and/or
Phone: ( 0 3) 2 Z S l g) � � relocation
S 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.' ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: branch circuit
Contact name: B. Fee for branch circuits // /
without service or feeder fee, ' 46.85 <(p •€ 2
Address: each branch circuit
Each add'] branch circuit 1 6.65 I %." 2
City/State/ZIP: Miscellaneous (service or feeder not included)
Phone: ( ) Pump or irrigation circle 53.40 2
I Fax: ( ) Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited-
CONTRACTOR energy panel, alteration, or
extension. Describe: Page 2 2
Business name: Z kG f+ r(�y s_e MO L G I
9 Address: u 0' S� sL*ALS Each additional inspection over allowable in any of the above
Per inspection 62.50
�� City/State /ZIP: VA�h �-� t�� IY0 ( I1 Investigation per hour (1 hr min) 62.50
I ,,,/7/ Phone: 360) (3 S o S ( Fax: : ( "�� 3f 01 99 a a vv 31 �� Industrial plant per hour 73.75
p f
ELECTRICAL PERMIT FEES*
CCB Lic.: i 37(o`�3 Electrical_ '7 .-g �, !emu , ' c.• • • �' 3 Subtotal f 9'3 js
Suprv. Electrician signature, required: W i, Plan review (25% of permit fee)
Print name: RA L S 0I\` Date: 42 Eli State surcharge (8% of permit fee) 15.146
�� r + TOTAL PERMIT FEE A 8 A Coo
Authorized signaWF • This permit application expires if a permit is not obtained within 180
(0/241 days after it has been accepted as complete
Print name: _. \ Date: /0 • Fee methodology set by Tri -County Building Industry Service Board
Number of inspections per permit allowed.
i:\ Building\ Pcrmits\ELC.PennitApp.doc 12103 44 615T(10 /02/COM/WEB
a, ..
Electrical Permit Application - City of Tigard
Page 2 -, Supplemental Information • .
LIMITED ENERGY PERMIT FEES:
;° RESIDENTIAL WO NLY: - —
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:
COM11*RCIAL WORK ONLY: •
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
,❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
i:\Build ngTamits\ELC- PamitApp.doc 04/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Jd-
Received /1 Date Requ sted ll AM PM BUP
/ /
Location l s 3.c Suite MEC
Contact Person Ph ( ) 9.03 — 5 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner /JeP Q J ELC °aeo -003
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:
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
JRTAIL
F
rve
Rough -In
UG/Slab
Low Voltage !►/O Clio
F � l arm
- ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
ti•'= - PART FAIL
SITE ❑ Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA Date /0/,‘
Approach/Sidewalk Inspect() Ext
Other:
Final DO NOT REMOVE this inspection recor • 'rem the ' b site.
PASS PART FAIL