Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2003 -00482
A I 4, DEVELOPMENT SERVICES DATE ISSUED: 8/6/03
..I I - ' 13125 SW Hall Blvd., Tidard, OR 97223 (503) 639 -4171
PARCEL: 2S102CB -00303
SITE ADDRESS: 13165 SW PACIFIC HWY
SUBDIVISION: NORTH TIGARDVILLE ADDITION ZONING. C -G
BLOCK: . • LOT : 033 JURISDICTION: TIG
' Project Description: JOB NO. 455 Tenant Improvement for A &W
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: l'
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: 14 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: - .
POORMAN, JOHN AND MARTHA WILLAMETTE ELECTRIC INC
14243 NW EVERGREEN ST " PO BOX 230547, ,
PORTLAND, OR 97229 TIGARD, OR 97281
J .
Phone: Phone: 503 - 624 - 3631
Reg #: LIC 75059
SUP 1965S
FEES ELE 34 -283C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit _ 8/6/03 $139.95
[TAX] 8% State Tax 8/6/03 $11.20 Ceiling Cover
Wall Cover
• Total $151.15 - 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 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.
Issued By: i P Sig s J 1
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:
. Call 639 -4175 by 7 :00pm for an inspection the next business day
•
•
Electrical Permit Application Received ,., A ... Electrical •A
• s Date/By: «(03 PermitNo.:G�GcR67)3 -' 2 �l o a
City of Tigard Planning Approval Sign
City
13125 SW Hall Blvd. RECEIVED Date/By: Permit No.: Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503 -639 -4171 Fax: U 9& 9
��UJ A' Post - Review Land Use
tw. t; r� Date/By: Case No.:
Juris.: Internet: www.ci.tigard.or.us a il fi ,;•� C o ntact
�. See Page 2 for
24 -hour Inspection Request: 50 ` ARD Name/Method: I ® S Information.
BUILDING DIVISION
,.,h' •. r. •.r t . r .N 7 r Ii P: N rJ.'e,:,.l! T
E 2� '• `'�, ;i� •;;= _ T YPEtOF.WORK`r5�s• };' : : : �,,�%' : F,it; , +,. , • : ;;; -�,.. [., PL ..�;,:.
:. :c� •�. ,' : :�� .• y E' :�� r1 C'' AN�REVIEW (Please' all that apP1Y)' :4 „•�•..... ;
New construction Demolition 0 Service over 225 amps- ❑Health-care facility
Addition/alteration /replacement - Other: CORrvice i ❑ Hazardous location
�, ❑ Service over 320 amps - rating of ❑ Building over 10,000 square feet,
'•'' .` ` ' •' ' ", CATEGORY :OF :CONSTRItcyIOp1.' : ;? ; ,t !. I & 2 family dwellings four or more residential units in
1 & 2- Family dwelling Commercial/Industrial ❑ System over 600 volts nominal one structure
Accessory Building Multi-Family ❑ Building over three stories ❑ Feeders, 400 amps or more
ry g y ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other:
'• M' ": ,` SITE I NFORMATIO and;I:OC ATIOf!i!`ti'/�'O �' "t; Submit sets of plans with any of the above.
Job site address: s(,J /� The above are not applicable to temporary construction service.
131 b� el, i }t c J'k,_) Y Nt tr.''an'u it' •.' :;.'iaM SCIIIEDULE!P' r.'; l,;'(;' K ` ;i' ' ► =PIir lyily.
Suite #: I Bldg. /Apt. #: Number of Inspections per permit allowed
Project Name: 4- it W Description . Qty Fee (ea.) Total 1
New residential- single or multi- family per
Cross street/Directions to job site: dwelling unit. Includes attached garage.
Service included: •
1000 sq. fL or less 145.15 4
Each additional 500 sq. fl. or portion thereof 33.40 I
Limited energy, residential 75.00 2
Subdivision: I Lot #: Limited energy, non residential 75.00 2
Tax map /parcel #: Each manufactured home or modular dwelling
s ": °; , .Vi ;:`.' :? :DESCRIPTION OFIV.O • NI ' service and/or feeder 90.90 2
Services or feeders - Installation,
T .o. s . ■ C.. / NA. alteration or relocation:
200 amps or less 80.30 2
201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
i - r i a • :i �z r , a r, l i p T 601 amps to 1000 amps - 240,60
',�,;t�",� . ER's, :'�'�. ���7. 1�.. 1. 1�.��.ks }.'t�utiu-�'��� :3'h.'1i 2
Over 1000 amps or volts 454.65 2
Name: Reconnect only 66.85 2
•
Address: Temporary services or feeders - installation,
alteration, or relocation:
City /State/Zip: 200 amps or less 66.85 1
Phone: Fax 201 amps to 400 amps 100.30 2
, , 4 ( 401 to 600 amps 133.75 2
la 13 T 5, ,,;'.. :
. ._ ': ® _ •CO . .A - 't '; R s S .. { s. Branch circuits - new, alteration, or
Name: extension per panel:
Addre A . Fee for branch circuits with purchase of
• service or feeder fee, each branch circuit 6.65 2
City /State/Zip: B. Fee for branch circuits without purchase of
46.85 y` r 2
service or feeder fee, first branch circuit ,
Phone: I Fax: Each additional branch circuit i Y 6.65 y 3 2
E -mail: Misc.(Service or feeder not included):
W , r r.�o . K Each pump or irrigating circle 53.40 2 •
Each sign or outline lighting 53.40 2
Job No: Lt S Signal circuit(s) or a limited energy panel,
alteration, or extension Page 2 2
Business Name: ui , It A M t it a £(. , r t c /-,- c Description:
Address: PO a,,,, z..,, sy 2- • - -
City / State/Zip: r x � �, Qn p T Each additional inspection over the allowable in any of the above:
Z k _
/ Per inspection per hour (min. 1 how) 62.50 •
Phone: 6 2 3 CI / • Fax: 424 - 2.9C &' Investigation fee:
CCB Lic. #: a — s Lic. #: 3y 21x3 L , ; ,, other:
5- ,�� ,j, :Y� %, °, , d n�r,�(; °�
- . . �a.�� :; � � '. •. � t . t>�1 . dial' ' � � � Wag . � � . �G'�' ° w��ri'� Gs� -�.: °, -
Supervising electrician A Subtotal $ 131, 1. s'
signature required: AY C,..� /� Plan Review (25% of Permit Fee) $
Print Name: A rF F', (-e Lic. #: MA c– C State Surcharge (8% of Permit Fee) $ / / , Zv
TOTAL PERMIT FEE - $ st< / y^ / , / f'
Authorized Notice: This permit application expires if a permit is not obtained within
Signature: Date: 180 days after it has been accepted as complete.
•Fee methodology set.by Trl- County Building Industry Service Board.
' (Please print name)
i:NDsts\Permit Forms\ElcPermitApp.doc 01/03
•
Electrical Permit Application - City . f Tigard
Page 2 - Supplemental Information • •
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all systems $75.00
Check Type of Work Involved:
Audio and Stereo Systems
❑ Burglar Alarm
0 Garage Door Opener
El Heating, Ventilation and Air Conditioning System
0 Vacuum Systems
O Other
COMMERCIAL WORK ONLY:
Fee for each system $75.00
(SEE OAR 918 - 260 -260)
Cheek Type of Work Involved:
E i Audio and Stereo Systems
Boiler Controls
Clock Systems
D Data Telecommunication Installation
Fire Alarm Installation
HVAC
Instrumentation
El Intercom and Paging Systems
•
Ej Landscape Irrigation Control
•
Medical
Nurse Calls
Ej Outdoor Landscape Lighting
ED Protective Signaling
Other
Number of Systems
* No licenses are required. Licenses are required for all
other installations
•
i :\Dsts'Permit Forms\ElcPermitAppPg2.doc 01/03
•
CITY OF TIGARD • 24 -Hour
•
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: . (503) 639 -41 1 MST
BUP
Received &OA / Date Requested • s I , M PM BUP
Location A' ay Suite MEC
Contact Person rA4 Ph ( ) 4z- PLM
Contractor A a.GPit t e Ph ( ) SWR
BUILDING Tenant/Owner ELC
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
Fire Alarm
Susp'd Ceiling
)41
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer S G .—a0 D — 00 J r) ` c( � • C
Rain Drains ► �` l
Catch Basin / Manhole C 6 S\k j — 5 0 0 -a,b c - s49
Storm Drain
Shower Pan
Other: •
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PAS ,P RT FAIL
C CTRI
Service
Rough -In
UG/Slab
Low Voltage
F� larm
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SS PART FAIL
SITE ❑ Please call for reinspection RE: Unable to inspect – no access
Fire Supply Line
ADA
Approach/Sidewalk Date /21„2-- /S 3 Inspector Ext
Other:
Final DO NOT REMOVE this inspection record f om the site.
PASS PART FAIL