Permit A • CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2005 -00539
—�1�'� DEVELOPMENT SERVICES DATE ISSUED: 7/28/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 1S136CD-00100
SITE ADDRESS: 11705 SW PACIFIC HWY ZONING: C -G
SUBDIVISION: PACIFIC CROSSROADS LOT : JURISDICTION: TIG
Project Description: Remove & replace 100 amp breaker. Job No. 71189
(This service is for entire building, not tenant specific.)
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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:
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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:
PACIFIC CROSSROADS PROPERTIES, I LH MORRIS ELECTRIC, INC
BY WYSE INVESTMENT SERVICES CO 7051 SW SANDBURG ST. #100
200 SW MARKET ST STE 345 TIGARD, OR 97223
PORTLAND, OR 97201
Phone: Phone: 503 - 639 - 2334
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FEES Reg #: LIC 1838
ELE 20 -39C
Description Date Amount SUP 3006S
[ELPRMT] ELC Permit 7/28/2005 $80.30
[TAX] 8% State Surcharge 7/28/2005 $6.42 REQUIRED ITEMS AND REPORTS
Total $86.72
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
susp ed for more : 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those
ru s are set forth in OAR •5 : • 01 0 through OAR 952 - 001 -0100. You may obtain copies of thesg.r.41es or direct questions OUNC at
5 3- 246 -6699 or 1- 800 -33 � i 344
I ued By: ' ....L___-4 / i �/ / / Permittee Sign , ture: _�: i 1���r ( i i0
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:
• TRACTOR INS ALLATION ONLY
SIGNATURE OF SUPR. EL r — iir A mon g
DATE:
LICENSE NO:
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day. .
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
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- 71189
Ele ?trical Permit Application FOR OFFICE USE ONLY
City of Tigard Received ,,/ Permit No.. J
�
■
J Dateiv / f. _ .. ,40'4.•• 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 -d '' 'iii Date/By: Other Permit:
Inspection Line: 503.639.4175 Date Ready/By: 1 • . El See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: / "lam Supplemental Information
• - TYPE OF WORK` . - PLAN REVIEW '
❑ New construction Addition /alteration /replacement . Please check all that apply:
❑ Demolition ❑Other: ❑Service over 225 amps, comm'l ['Hazardous location
['Service over 320 amps — rating ❑ Buildng over 10,000 sq. ft.,
' CATEGORY 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 ['Manufactured structures or
JOB SITE INFORMATION AND LOCATION ['Egress/lighting plan RV park
Job no.:71 1 89 Job site address: 1 1 705 SW PACIFIC HWY ❑ Health -care facility ['Other:
Submit 2 sets of plans with any of the above.
City/State /ZIP: TIGARD OR 97223 The above are not applicable to temporary construction service.
FEE* SCHEDULE
Suite/bldg. /apt. no.: Project name: PACIFIC CROSSROADS
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'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
REMOVE /REPLACE 100A BREAKER dwelling, service and/or feeder _ 90.90 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 1 80.30 8 0. 3 0 2
15 PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: PACIFIC CROSSROADS PROPERTIES INC 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 r 2
Reconnect only 66.85 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
• relocation
Phone: ( ) 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: L.H. MORRIS ELECTRIC INC branch circuit
B. Fee for branch circuits
• Contact name: TIM METCALF 880-5285 without service or feeder fee, 46.85 2
each branch circuit
Address: Each add'l branch circuit 6.65 2
City/State/ZIP: Miscellaneous (service or feeder not included)
Phone: (503) 631 - 2334 Fax: : ( ) Pump or irrigation circle 53.40 2
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: L.H. MORRIS ELECTRIC INC
Address: 7051 SW SANDBURG ST #100 Each additional inspection over allowable in any of the above
Per inspection 62.50
City/State/ZIP: TIGARD OR 97223 Investigation per hour (I hr min) 62.50
Phone: (503) 631 -2334 Fax: (503) 620 - 7405 Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
CCB Lic.: 1838 Electrical Lic.: 20 -39C Suprv. Lic.: 3006S Subtotal 80.30
Suprv. Electrician signature, required: / . Plan review (25% of permit fee) 4 Print name: GARY ll' EOPL Dat/ State surcharge (8% of permit fee) 6.42
TOTAL PERMIT FEE 86.72
Authorized signatur ' ^ T his permit application expires If a permit is not obtained within 180
(1d days after It has been accepted as complete
Print name: Date: • Fee methodology set by Tri -County Building Industry Service Board
•• Number of inspections per permit allowed.
i:\ Building \Pernits\ELC- PermitApp.doc 12/03 440- 4615T(10 /02/COM/WEB
_ liilly
OF TIGARD :
1 BUILDING DIVISION PERMIT #: ELC2005 -00539
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/28/2005
Phone: (503) 639 -4171 P^ Nd4pq�i ,fr� <I
Inspection Requests (24 Hrs.): (503) 639 -4175 " —
INSPECTION WORKSHEET FOR DATE: 7/29/20Q5 TIME: 7 :07AM PAGE: 79
SITE ADDRESS: 11705 SW PACIF Li. W Y It CLASS OF WORK:
SUBDIVISION: PACIFIC CROSSROrv LOT #: TYPE OF USE:
PROJECT NAME: PACIFIC CROSSROAD r
DESCRIPTION: Remove & replace 100 mull! eaker. Job No. 71189
(This service is for entire bui Eitu`, not tenant specific.)
OWNER: PACIFIC CROSSROADS PR ° 'TIES, I, PHONE #:
CONTRACTOR: LH MORRIS ELECTRIC, INC PHONE #: 503 - 639-2334
Inspection Request Scheduled For: Date: 29/2005 Pour Time:
Code # Ins. - . Description Confirm Contact # Message
115 ectrical service 012428 -01 503 - 880.5285 N
\ ;I
Corrections /Comments /Instructions:
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X PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
(` A J Inspector: • V Date: 2- I I Phone #: (503) 718-