Permit CITY OF- TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00791
`,In DEVELOPMENT SERVICES DATE ISSUED: 12/10/2004
All 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2 S 102 C 6 -00200
SITE ADDRESS: 13137 SW PACIFIC HWY
SUBDIVISION: NORTH TIGARDVILLE ADDITION ZONING: R -12
BLOCK: LOT : 041 JURISDICTION: TIG
Project Description: Provide a 200 amp meter main.
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: SIGNALIPANEL:
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: 1 PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 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:
TIGARD- TUALATIN SCHOOL DISTRICT ATLAS ELECTRICAL CONTRACTORS
6960 SW SANDBURG ST 4403 SE ROETH E RD
TIGARD, OR 97223 - MILWAUKIE, OR 97267
Phone: 503 - 431 -4000 Phone: 659 -2212
Reg #: SUP 2581S
LIC 1532
FEES ELE 3 -2C
Description Date Amount Required Inspections •
[ELPRMT] ELC Permit 12/10/200' $86.95
[TAX] 8% State Surcharge 12/10/200' $6.96 Rough -in
Elect'I Final
Total $93.91
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 -2344.
Issued By: -uZ., Permit Signature:, gN
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 • FOR OFFICE USE ONLY
c /
Date/By: , D O 7 . �� t. C.�ZOO 5 / O4 ?g /
Guy of Tigard Permit No.: G
'13125 SW Hall Blvd., Tigard,OR 9722 fIECEIVE , Pl Review
Phone: 503.639.4171 Fax: 503.598. l 0 ('�� Other Permit:
i�
il Date/By: Inspection Line: 503.639.4175 Date Ready/By: hulls: ® See Page 2 for
Internet: www.ci.tigard.or.us DEC 10 2004 Notified/Method: 176" Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction Ea AStaki4101ffacement Please check all that apply:
El Demolition ILDING DIVISION OService over 225 amps, comm'I ['Hazardous location
❑ Ot er:
❑Service over 320 amps — rating ❑Bulldog over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential
❑ 1- 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 DEgress/lighting plan RV park
Job no.: Job site address: ❑Health -care facility ❑Other:
1225Fi 13137 SW Pacific Hwy Submit 2 sets of plans with any of the above.
City/State /ZIP: Tigard, Oregon 97223 The above are not applicable to temporary construction service.
FEE* SCHEDULE
Suite /bldg. /apt. no.: Project name: Tigard Tualatin School Dist
Deseriptioa I Qty. I Fee. I Total
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
Limited energy, residential 75.00 2
Tax map /parcel no.: Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Provide a 200 amp meter main. Services or feeders installation, alteration, and/or relocation
200 amps or less 1 80.30 80.30 2
201 amps to 400 amps 106.85 2
El PROPERTY OWNER [ TENANT
401 amps to 600 amps 160.60 2
Name: Tigard Tualatin School District 601 amps to 1,000 amps 240.60 2
Address: 13137 SW Pacific Hwy Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/State /ZIP: Tigard, Oregon 97223 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
g APPLICANT I ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each
Business name: Atlas Electrical Contractors, Inc. branch circuit 1 6.65 6.65 2
B. Fee for branch circuits
Contact name: Ty Shepersky without service or feeder fee, 46.85 2
Address: 4403 SE Roethe Road each branch circuit
Each add'I branch circuit 6.65 2
City /State/ZIP: Milwaukie, Oregon 97267 Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: (503) 659 -2212 Fax: : (503659 -4944 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: Atlas F,1 sstrical Contrac:tnrsi_Tnc.
A Address: 4403 SE Roethe Road Each additional inspection over allowable in any of the above
■ Per inspection 62.50
1 City /State /ZIP: Milwaukie, Oregon 97267 Investigation per hour (I hrmin) 62.50
Q• l
E LL
S, Phone: km) 559 -2212 Fax (5 iO3( 9 -4944 Industrial plant p hour 7 ECTRICAL PERMIT FEES*
S*
o ff , CCB Li c.: 1 Electrical Lic 3_ 7' /o Suprv. Lic.: 5009S Subtotal 86.95
Suprv. Electrician signature, required: ,� Plan review (25% of permit fee)
State surchar ge ( 8% of p ermit fee) 6.96
Print name: Ty Shepe sk 1 Date: 12/9/04
TOTAL PERMIT FEE 93.91
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: Ty Shepe ky Date: 12/9/04 • Fee methodology set by Tri- County Building Industry Service Board
•• Number of inspections per permit allowed.
i:\ Building \Permits\ELC- PermitApp.doc 12/03 440-461ST(10 /02/COMM'EB
CITY OF TIGARD 24- Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested / e ? 3 AM PM BUP
Location /3/ 37 r Suite MEC
Contact Person Ph ( ) (o .5
Contractor Ph ( ) SWR
BUILDING Tenant/Owner
ELC � /9cr — c/O 7
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: /� 1 SIT
Post & Beam L
Shear Anchors \
Ext Sheath/Shear �.7?
Int Sheath/Shear
Framing
Insulation - V kk) 11
. 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
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
AS PART FAIL
SITE 0 Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA ,�
Approach/Sidewalk Date / / 1 / Inspector j!+Ar ,✓l, ,� Ext
Other:
Final DO NOT REMOVE this inspection record from t ob site.
PASS PART FAIL