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Permit A.,. CITY O GARD ELECTRICAL PERMIT PERMIT #: ELC2004 -00178 DEVELOPMENT SERVICES DATE ISSUED: 4/8/04 13125 SW Hall Blvd., Tigard. OR 97223 (503) 639 - 4171 PARCEL: 1S136CD-01001 SITE ADDRESS: 11747 SW PACIFIC HWY SUBDIVISION: ZONING. C -G BLOCK: LOT : JURISDICTION: TIG Project Description: Install (1) branch circuit. 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: 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: CHEVRON U S A INC NORTHWEST PUMP + EQUIPMENT PO BOX 285 2800 NW 31ST HOUSTON, 1X 77001 PORTLAND, OR 97210 Phone: Phone: 227 - 7867 Reg #: ELE 26 -852C LIC 64567 FEES SUP 4884S Description Date Amount Required Inspections [TAX] 8% State Surcharge 4/8/04 $3.75 [ELPRMT] ELC Permit 4/8/04 $46.85 Rough -in Elect'l Final Total $50.60 This Permit is issued subjed 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 - 2344. 4 Issued By: Permit Signature: 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: ,2/(J /9/' )"LI C�-� �of DATE: LICENSE NO: Call 639 -4175 by 7:00pm for an inspection the next business day Electrical .Etrni afi / FOR OFFICE USE ONLY City of'Tigard Received _ _ 2UU4 Date /B 0 1� r Permit No �/ �% / / /, i - 13125 SW Hall Blvd., Tigard, OR 972'pv - Plan Revie , { � Other Permit: Phone: 503.639.4171 Fax: 503.598'1960 mi Date/By: Inspection Line: 503.639.4175 CITY OF TIGARD 11- Date Ready /By: Jura: ® See Page 2 for Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information RI In niNG nlvlsloN TYPE OF WORK i PLAN REVIEW ❑ New construction K Addition /alteration/replacement Please check all that apply: CI 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 l- and 2- family dwellings 4 or more new residential ❑ I- 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 stories ❑Feeders, 400 amps or more ❑Occupant load over 99 persons ['Manufactured structures or JOB SITE INFORMATION AND LOCATION ❑Egress /lighting plan RV park +r1 �$ �7 / ❑Health -care facility ❑Other: Iv lob no.: 6 Job site address: , '7 L f '� s paCI �� /`t Submit 2 sets of plans with any of the above. City /State /ZIP: 1- 1/7 Pr /� O fl / q 'l Z23 The above are not applicable to temporary construction service. Suite /bldg. /apt. no.: Project name: C� ejr-� t1/4) Description SCHEDULE 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' I Tax map /parcel no.: Limited energy, residential 75.00 2 Limited energy, non - residential 75.00 2 DESCRIPTION OF WORK Each manufactured or modular �,� �j• dwelling, service and /or feeder 90.90 2 �+^� ''� i t 5 T. Services or feeders installation, alteration, and/or relocation 200 amps or less 80.30 2 lil 201 amps to 400 a s 106.85 2 PROPERTY OWNER I ❑ TENANT 401 amps to 600 amps 160.60 2 Name: (Is U yQ\v (L A 601 amps to 1,000 amps 240.60 2 Address: 6k- S ^ 1..(�vCw Over 1,000 amps or volts 454.65 2 ' p L _ Reconnect only 66.85 2 City /State /ZIP: (/ 1 q , 2 Temporary services or feeders installation, alteration, and /or �c� � I I J 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 A. Fee for branch circuits with '� CONTACT PERSON 1 service or feeder fee, each 6.65 2 Business name: f jL v i r ,,,, - .,, , \ branch circuit V �` 'L B. Fee for branch circuits Contact name: 17.7.-Rc I ^ / P ki without service or feeder fee, ) 46.85 2 Y' each branch circuit / Address: /15 �w 3 S S 0 \ Each add'I branch circuit 6.65 2 City /State /ZIP: ], T ( ti� ( 'yy 7 C' a( 0 Miscellaneous (service or feeder not included) `i ( q06 q • ` I Fax: ( ) Pump or irrigation circle 53.40 2 (v 3) ttJJ Phone: 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: (Oa l� yT LJe.)T i -+- r Address: do bvl l I" / 5=1: Each additional inspection over allowable in any of the above SSS 1 Per inspection 62.50 City /State /ZIP: •�d I -G� ,y o q 1 P.( 6 Investigation per hour (I hr min) 62.50 Phone: (1 ) �'] 4-- 7 ( 6 (, / I Fax ( ) Industrial plant per hour 73.75 ` • ELECTRICAL PERMIT FEES* CCB Lie.: (4c.J(O Electrical Lic.: . o. . 1� 4 v. Lie.: Lf Subtotal et( $ S' Suprv. Electrician sigrYr I�rired: %, C, /. % Plan review (25% of permit fee) ‘, State surcharge (8% of permit fee) 3, 7s Print name: e'..-Pi-ti -1k1A.-.0 . J Date: 7� 04 � - G O TOTAL PERMIT FEE Authorized signatures �� This permit application expires if a permit is not obtained within 180 ..--r _ — days after it has been accepted as complete Print name: - `, ili-e" Date: el 56 U C r • Fee methodology set by Tri -County Building Industry Service Board T •" Number of inspections per permit allowed. i Mnuilding \Permits \ELC- PermitApp.doc 12/03 440-461 5T( l 0 /02 /COM /WEB CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503j 639 -4175 INSPECTION DIVISION Business Line: (503) 639 - 4171 MST BUP Received Date Re uested � 4-f AM PM BUP Location I / 79-7 _ Suite MEC Contact Person Ph ( ) s q —� PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner L%+'t -Y ELC — 6 O / 7 8 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 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 PASS PART FAIL ELECTRICAL • Service /dough -In UG/Slab Low Voltage J Fire Alarm ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. 4E0 PART FAIL SI Please II for reinspection RE: Unable to inspect - no access Fire Supply Line Q Inspector NOB \I Ext ADA 1 Approach/Sidewalk Date 4 Other: Final DO NOT REMOVE this inspection record from the Job site. PASS PART FAIL