Permit C ITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00734
A4- ''
I. DEVELOPMENT Ir SERVICES 97223 DATE ISSUED: 11/16/2004
(503) 639 -4171
PARCEL: 1S135DD-03301
SITE ADDRESS: 11945 SW PACIFIC HWY 200
SUBDIVISION: HOFFARBER TRACTS NO.1 ZONING: C -G
BLOCK: LOT : 002 JURISDICTION: TIG
Project Description: (3) 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: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 2 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 PROPERTIES INC TODD ESSLES ELECTRIC
2106 SE OCHOCO ST 24824 S NEWKIRCHNER RD.
MILWAUKIE, OR 97222 OREGON CITY, OR 97045
Phone: Phone: 503 - 632 - 2232
Reg #: ELE 3 -523C
SUP 3155S
FEES LIC 148359
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 11/16/200' $60.15
[TAX] 8% State Surcharge 11/16/200' $4.82 Rough -
Elect'I Final
Total $64.97
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 -0699 or 1 -000- -2344.
Issued By: .114-1& 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: DATE:
LICENSE NO: 5 SS
•
Call 639 -4175 by 7:00pm for an inspection the next business day
nr
Electric#1 Permit Applicatift I ''' '—'-' FOR OFFICE USE ONLY
City of Tigard ,
- 2',''',k.. Received
Date/B : // /e a ,-/ 8 - Permit NoC /-o 73i/
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 ,,'‘f r • --__-. - 7 • :;:d ir..24Yi I A Date/8 : Other Permit:
Inspection Line: 503.639.4175 ,, o L ■\-■, — „ill
Date Ready/By: el See Page 2 for
Internet: www.ci.tigard.or.us ' ,.?, 1 ,- ,, 1 X (t.,' _:, TT,L - - Notified/Method: .1x/isria
Supplemental Information
y - siii...
''.=' e.:± t.4 -':',:- -':',. kole , ';'-'..... ^..77.r. W 1. .- , ..• ••••,. : : t.., • -
0 New construction 0 Addition/alteration/replacement Please check all that apply:
0
0Service over 225 amps, comm'l 0 Hazardous location
Demolition 12 Other:
, . ,. OService over 320 arnps - rating 0Buildng over 10,000 sq. ft.,
..?;:i. 4.E of 1- and 2-family dwellings 4 or more new residential
;..;0!..-.;.1. --e ..,..,.- , ...-".. _.',...... - ...,.g-,,, - _,.... ,:. „. Os.-.v..... e. ;
o 1 and 2 dwelling Commercial/industrial 0 Accessory building 0System over 600 volts nominal units in one structure
['Building over three stories 0Feeders, 400 amps or more
0 Multi Mastex builder 0 Other: . , ['Occupant load over 99 persons ['Manufactured structures or
k":-efA•f W5 ieiii
'''ktii .",' iiiiildei‘fak.:='-'81tent '''' Z4 El Egress/lighting plan RV park
..-:`,., ---,!...-,-..._..:-_,..__ .... - ...-4. ,..., .-..., ..,,,...,:. . • - ,,,.., ..,D, - `
0Health-care facility 00ther:
Job no.: Job site address: 1 1 q 4 s - s -..„, p et hc _ 4,,,_,
i „, j f Submit 2 sets of plans with any of the above.
City/State/ZIP: •..-
The above are not applicable to temporary construction service.
:V:,.:',.{-„:ii47-:iiltle,,ci,WRS,O,M4ki+.'Zi.T.::if..5;,;.::::::'• ••":". ' ":. ' -. ''' ..-.
Suite/bldg./apt. no.: !.7 6 Project name: it bagli I S el Description I Qty. I Fee. 1 Total I **
Cross street/directions to job site: (4 1 i 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
Limited energy, residential 75.00 2
Tax map/parcel no.: , .
Limited energy, non 75.00 • 2
AV !Y - s,":;-- C ':':rrc'-;4 : 4**fitl:00 1 `C'0 - 4 - 7 - .....(M-15157ntafib7, - ;'?;" - !i:.( - ff.:. i4 ,;,t Each manufactured or modular
- dwelling, service and/or feeder 90.90 2
C , .-- 4:: j. r c 17 n1vc s 1- 1,4144
1 l' Services or feeders installation, alteration, and/or relocation
ti d,c.v.v. 200 amps or less 80.30 2
'. ' "- • - . " L , Or R %OWNER' ..'-',.:- .., i' .., • ''72,- .'!..:''..". ''','''';,- , T ANTI '''
t: ' ' ' 201 amps to 400 amps 106.85 2
"--s.. ' . - -'4- -- • '-'-' -- -- ' -''" ' "...---'" • . ' - — ' - '- - - "..-'-' '-'-'-' -"' ''-- 401 amps to 600 amps 160.60 2
Name:
fl oc, 3 A.,1 0 ,.... 601 amps to 1,000 amps 240.60 2
Address: 1 1, '9 i l S S Pa E Cd 14 Over 1,000 amps or volts 454.65 2
Reconnect only - 66.85 2
City/State/ZIP: - ) ,, 4 Tempor 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
: bl...,,,,;' , A-.7?.'-'-'4.123..,.:'-tj:;t 1 tipirp,keti:iipWii0t..;::,: ..
• A. Fee for branch circuits with • :1'' -.74■ :. r - ,;.-, e''-r - di kt ''.- --•',,, - -, - 7•27.7. 4, _ ° ; v service or feeder fee, each
6.65 2
Business name: branch circuit
B. Fee for branch circuits
Contact name:
7
Address:
without service or feeder fee, I
each branch circuit
Each addl branch circuit 2 '
6.65 1'3,7o 2
City/State/ZIP:
Miscellaneous (service or feeder not included)
5 116 .g5" 2
Pump or irrigation circle 53.40 2
Phone: ( ) Fax: : ( ) Sign or outline lighting 53.40 2
E Signal circuit(s) or limited-
' tolsititizeititt..3. 7. ?..;`3i - - . : - . 4 ,,,::;:: . 4.':47 - lif,.4..::..i,::ti'i energy panel, alteration, or
extension. Describe: Page 2 2
Business name: . - r 0 44 4 ec c, I..e 5 0 e _j„...: c _.
Address: 1 , s ,v,,,,,, k
Each additional inspection over allowable in any of the above
r ,% ei , 9 n., ,,,..,,,, y ., e4 „.. a_d .
tf) Per inspection 62.50
City/State/ZIP: ea c._,-, ce. 1 ?--0 Li r Investigation per hour (1 In min) 62.50
I Industrial plant per hour 73.75
'.0 Phone: ( ) Ce7-1. sz-a ' Fax: (, cr-si -
1 CCB Lic.: ii p3 9 Electrical Lic.: ?.... s-2 3 c Suprv. Lic.: - ,r/ gs- S'
c-- . Subtotal
Suprv. Electrician signature, required: 77 - .' ......‘,... f° - I . Plan review (25% of permit fee)
State surcharge (8% of permit fee) 4,S
Print name: 01,...k . n Ko Date: //..... / t , of
TOTAL PERMIT FEE
Authorized signature: -- ----......--- e ...---.. This permit application expires If a permit is not obtained within 180
days after it has been accepted as complete
Print name: .-- 4 j CC_ C.3
14 c / Date: I /..... 1 1 — l O e • Fee methodology set by Tri-County Building Industry Service Board
a * Number of inspections per permit allowed.
iABuildingTennits \ELC-PerrnitApp.doc 12/03 440-4615T(10/02/COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
R . Y
LIMITED ENERGY PERMIT FEES:
M
&® i:.Y Wp - dvE
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:
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:\Building\Pc mits \ELC- PemtitApp.doc 04/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: _(503) 639 -4175
INSPECTION DIVISION . Business Line: (503) 639 -4171 MST
BUP
Received r Date Requested `/' / 7 AM PM BUP
Location / / 9 L S P Suite c MEC
Contact Person '-!.� Ph ( ) l D 3,7 -3 a PLM
Contractor Ph ( ) SWR L /
BUILDING Tenant/Owner ELC ;760 ! � 7 -6 754'
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: ,, �yyr SIT
Post & Beam �% r,.0 td- C/
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 ►�I I
Rain Drains ►!
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
ASS PART FAIL
S
UG/Slab 2 — —
Low Voltage j✓'
Alarm
PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SITE Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA / �
Approach/Sidewalk Date / / �� O Inspecto �/I/1 ��';�"`"� ��✓` ^/ Ext
Other:
Final DO NOT REMOVE this inspection record from the ob site.
PASS PART FAIL