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Permit • ,., CITY OF TIGAR.D ' ;' ELECTRICAL PERMIT PERMIT #: ELC2004 -00736 i DEVELOPMENT SERVICES DATE ISSUED: 11/16/2004 V' �i 13125 SW Hall Blvd., Tigard. OR 97223 (503) 639 -4171 PARCEL: 2S 102BD -01200 SITE ADDRESS: 12825 SW PACIFIC HWY SUBDIVISION: NO. TIGARDVILLE ADDITION AMEND ZONING. C - BLOCK: LOT : 008 JURISDICTION: TIG Project Description: Network cabling & (2) circuits for registers. 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: 1 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: CONOCO PHILLIPS COMPANY SME CORPORATION 600 N DAIRY ASHFORD 6550 N INTERSTATE AVE HOUSTON, D( 77079 PORTLAND, OR 97217 Phone: 206- 706 -2340 Phone: 503 - 286 -3728 Reg #: LIC 40659 ELE 26 -556C FEES SUP 4214S Description Date Amount Required Inspections [ELPRMT] ELC Permit 11/16/2004 $128.50 [TAX] 8% State Surcharge 11/16/200 $10.28 Low Voltage Inspection Rough -in Total $138.78 Elect'I Final 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 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: - DATE: 4 LICENSE NO: .54 1- . 5 Call 639 -4175 by 7:00pm for an inspection the next business day / Electrical Permit Application— G VE — -- - - FOR OFFICE USE ONLY ... - City of Tigard / alt Received I ...7 _ 4 Date/By: Permit No.: / ' /6/ op- 7 A 13125 SW Hall Blvd., Tigard, OR 97223 NOV 1 6 280 Plan Review 4 ,,,, , q , _.,-" Phone: 503.639.4171 Fax. 503.598.1960 Date/B : Other Permit: Inspection Line: .503.639.4175 L'ITY OF TIGAR --!..., Date Ready/By: NE 121 See Page 2 for rn Inteet: www.ci.tigard.or.us ataDiNG nitite.. Notified/Method: Supplemental Information e-ik: ,.:!: -' ' lx,A•kdia„, ,,,;' , .1:,L.,, kv ..•.-- -. " E] New construction Addition/alteration/replacement Please check all that apply: D ['Service over 225 amps, comm'l E Hazardous location Demolition E Other: . 0 Service over 320 amps - rating EBuildng over 10,000 sq. ft., WV *Wrinidgifka .a of 1- and 2-family dwellings 4 or more new residential 0 1- and 2-family dwelling aCommercialhndustrial 0 Accessory building El System over 600 volts nominal units in one structure EBuilding over three stories ['Feeders, 400 amps or more 0 Multi-family . El Master builder D Other: El Occupant load over 99 persons ['Manufactured structures or '1,3,1101,0 t • i : 1 ) , M I : f : t i l a l i t 1 , 1 1 C 7 4 . 4 V 4 , 1 [I E gre s s /1 i gh tin g plan RV. park EHealth-care facility El Other: Job no.: 2_70 3 - 9 i, 9 Job site address: ) z4. 2.._s:- ,.. p Al Submit 2 sets of plans with any of the above. City/State/ZIP: 71._/6_4/2/2 42- i The above are not applicable to temporary construction service. 1.13AM„- el-gki?470CIRe§r415WI-7 i.::7!• ' Suite/bldg./apt. no.: Project name: 4 w i t , 6 Description Qty. Fee. Total ** Cross street/directions to job site: l e3t4 F 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 1 Limited energy, residential 75.00 2 Tax map/parcel no.: . Limited energy, non-residential 1 75.00 2 f&IM4, illifi if Each manufactured or modular , dwelling, service and/or feeder 90.90 2 'OA._ 6-AA/ C-- 4 2- c/o , /vez,r /I/4/0 Services or feeders installation, alteration, and/or relocation ff4- 5 AL&isf€4... ( (ri 200 amps or less 80.30 2 ATIPingfiffipilifP'''Milla,"CinilrfrfitIfW9friAVy. lid:WOW:i 201 amps to 400 amps 106.85 2 VIlift.4,:i4,.. •,.A:;,,, • 'AI,,,,,,,,IIIi. Y, -• 4,,4-r.,AliWav400-•,..14,-,,„*A•ra,.A24.-Votzel,Falift 401 amps to 600 amps 160.60 2 Name: 601 amps to 1,000 amps 240.60 2 Address: Over 1,000 amps or volts _ 454.65 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 WairtZgrAVIZAWEreAV , ,AggifiLVOMMVOMIVE - 06,40:4* A. Fee for branch circuits with service or feeder fee, each 6.65 2 Business name: branch circuit B. Fee for branch circuits Contact name: without service or feeder fee, ) (46\ each branch circuit Address: Each add'l branch circuit 6.65 2 City/State/ZIP: Miscellaneous (service or feeder not inclu e Pump or irrigation circle 53.40 2 Phone: ( ) Fax: : ( ) Sign or outline lighting 53.40 2 E-mail: Signal circuit(s) or limited- smarmat fogniz,0001:4"tothwetega- gmisinam energy panel, alteration, or extension. Describe: Page 2 2 Business name: Each additional inspection over allowable in any of the above Address: , c5 - 0 4/, ..,r,,,,/,,, ..._,,,..,z_ Per inspection 62.50 City/State/ZIP: p / ,,,,rte.... / .3 72 24 "-7 Investigation per hour (1 hr min) 62.50 Phone/ ( 800) 5 - - 5---0 — 1 s 7 5--- Fax: ( ) Industrial plant per hour 73.75 M. 4' MICARPWItigUt Wr7=''' CCB Lic.: Li 0 4 5 Electrical Lic.:-$S r_ Suprv. Lic.: Li u ti 5 Subtotal • Suprv. Electrician signature, required: Plan review (25% of permit fee) -› State surcharge (8% of permit fee) jd Print name *Lc.( R e - 0 A - V 1 S Date: 1/40/0, TOTAL PERMIT FEE /,__. 7 )1' Authorized signature: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete Print name: Date: • Fee methodology set by Tri-County Building Industry Service Board 0 * Number of inspections.per permit allowed. i: \ Building \ Perrnits \ ELC-PermitApp.doc 12/03 440-4615T(10/02/COWWEB Electrical Permit Application - City of Tigard r. Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: Fee for all residential systems combined ... $75.00 Check Type of Work Involved: El Audio and Stereo Systems* ❑ Burglar Alarm ❑ Garage Door Opener* ❑ Heating, Ventilation and Air Conditioning System* El Vacuum Systems* ❑ Other: fmE Fee for each commercial system $75.00 (SEE OAR 918 - 260 -260) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems El Data Telecommunication Installation El Fire Alarm Installation ❑ HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls Outdoor Landscape Lighting* ❑ Protective Signaling El Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations i: \ Building \Permits \ELC•PermitApp.doc 04/03 CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 INSPECTION DIVISION Business Line: (503) 639 -4171 MST / Q� BUP -- Received Date Requested c (e AM PM BUP Location / D a S I U -il Suite MEC Contact Person Ph ( gZIO ) 1E PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner '7 ELC °L�D y " bo 73 Footing Foundation ELC Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler C Fire Alarm L Susp'd Ceiling Roof Other: lAff Final PASS PART FAIL `,.PLUMBING �= Post & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: Final PASS PART FAIL - MECHANICAL Post & Beam Rough -In Gas Line Smoke Dampers Final PASS PART FAIL ELECTRICAL'» °e. Service Rough -In UG/Slab Low Voltage Fire Alarm Reinspection fee of .$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. 1 PART FAIL SITE call for reinspection RE: Li Unable to inspect — no access Fire Supply Line ADA .— [i� �. O vi Approach/Sidewalk Date ` \ Inspector A`� S� Est Other: Final DO NOT REMOVE this inspection record from the Job site. PASS PART FAIL