Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00571
,w l DEVELOPMENT SERVICE DATE ISSUED: 9/9/2004
-1J(.. 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 - 4171
PARCEL: 2S1026D -03100
SITE ADDRESS: 13055 SW PACIFIC HWY
SUBDIVISION: NORTH TIGARDVILLE ADDITION ZONING. C -G
BLOCK: LOT : 035 JURISDICTION: TIG
Project Description: New service 200 amp - 3 phase (panel only) circuit for new lift.
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: 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:
MIDAS PROPERTIES INC GARNER ELECTRIC
ATTN: REAL ESTATE TAX DEPT 2920 SW 247TH AVE #A
225 NORTH MICHIGAN AVE HILLSBORO, OR 97123
CHICAGO, IL 60601
Phone: Phone: 503 - 648 -4552
Reg #: LIC 121159 -
SUP 3707S
FEES ELE 34 -305C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 9/9/2004 $86.95
[TAX] 8% State Surcharge 9/9/2004 $6.95 Rough -
Elect'I Final
Total $93.90
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Speaalty 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: ,___s Permit Signature: p,
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
10/24/2002 01:22 6427925 PAGE 01
Blet>x ical Permit A 1 V GD ,, FOlt OFFICE: USE ONI.v
•
City of Tigard `a - Q - p _ � Permit No.: 1L 6 / d'/ "() $ 7 ) alc'
13125 SW Hall Blvd., Tigard, OR 97223 SEP U 200 p� Review
Phone: 503.639.4171 'Fax: 503.598 -1960, x' " "{
• Inspector Liao: 503.639.4175 TIGAR ° ■ � .a. ` ' r •..., • D pee R� Sea Page Z for
Internet www.ci.tigard,or.us
CITY G °ISIS • Notified/Method Supplemental lnformedoa
i 1 s `:''' r . � (! , r I .'' '- , ,_ ) 1 I r l l i v,, l ' � n J ; >I •1 : ll l
::. _ , w t r Y Y N 4y 4 , 7 • . •?��� i � r K ` p `? l� 1 I r Y 1t L r - ' 0 . •
`'ef __.l .r wri i:'. ‘ �3 : , . iJ 1 >._L. r:. _i _ 1S. � .C: C a h�"{ La 1 � - Flit > >kt
,rn r .l;'�. ...:±,ts._.,:n w ? ., . . :4` .
New construction rA Addhios/alteration/replacement please check all that apply:
❑I']
II De[txoltnon Other
['Service over 225 amps, conuit'I azardous location
❑ Service over 320•amps - rating • ❑ Buildng over 10,000 sq. R
ly 1 !' ' 14 1 I , t , a 4 11 ' ') I , 1 I •�� r , . I j, 1 L r i H'• of I- and fanal ,
4f .r ; ? 1 I1. 1 c , _,.. + .:; • u,,, ;ar,.:...��� r :.1r.�t 9
i t �:�i_.J:2 Y dwellings 4 or more new residential
0 1- and 2- family dwelling 6'' Commercial/industrial ❑ Accessory building ❑System over 600 volts seminal units in one structure
Multi-family
['Building over three stories . OPeeders, 400 amps or more
■Master builder Other: ['Occupant lead over p ersons ['Manufactured Structures or
! I J f .4 ) M
1j t 1 I • fl ' 4 + 1, ' , I I ' I ■ . r 1 , I rt , 1, • , . , Mt park
i 17 2 C :1. . r ,Sr i `', d , !; , o. ...).-,"1'.,'
f ,I 1�_ II ' ) ,.h o r U g t.wn 99 .persons
�.E�_,. , - . .. . � t _ .?. I, r l 5 1 . / r_ a ,t c^la., ._ Q �gIC39/11 6 +".. Y plan �Qtber,
3 055 �/ 'p,{�&
['Health-care facility
Job no.: � Job site address:
Submit sets of plans with any of the above. '
City/ State/ZIP: , , O The above are not applicable to temporary construction service.
k i.11 1 . n ...? lio c -,4 47 , •;;' , " r i t e ' t'-:.;.• ,
Suite/bldg. /apt. no.: Project n1=8: a I 1 u , ±, ;' ... ••
Description Qty. Fm. Total
Crean 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. ad 500 sq. ft. or portion 33.40 1
d'l
,PP�cel Limited energy, residential 75.00 2
Limited energy, axon- residential 75.00 2
, iSl rl � ( : 4,x A 1 I . r ,
f . rt ci q'1 ! , a � gl' 1 ;t .,, " ,V ....;'''.7";: i °'� r
12. :1:1 n;,r_ ?. .3 �` l
._ '',_'..'. . ".
. ,. ` ' ..'.3• ?_a / rn: ' .• . rt. ` `_ r tac`.1.;..�..:._ttl ✓. r �. •:.`- ` ..�:i, Each manufactured or modular
A _,�
. I - 0h' dwelling, service and/or feeder 90.90 _
200 A 2
- �N ( l ! • Ser ilea or feeders inatallatioo, alteration, and/or relocatio
GAer-itit New 1,,2 200 amps or less ` 80.30 jah•'C 2
r ., r I 'i 1 nt i s ,1 S r n 201 anlps to 400 amps 106.85 2
vr I .I J 1 1 f 11 r ' .f r 'I II I �,l � 11 t tl Y I I Z ` f t l t t 't ; , 1- littl l
� i .
i_.., l .,.) ?:..c i = ,i.t.�1_ ._� _ ". t__._.. r .....J.",h� t 4 +..� „ °i� . d.. _: ' . 4,n_,�rI..J'.lI:L r��
401 amps to 600 amps 160.60 2
Nairn: j . tat 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
Fes 200 amps or leas 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 arry� to 600 arrrp 133.75 2
Owner sigtxat ulre: Date: Branch circuits - new, alteration, or extension, per pane!
‘ ` { I y• 1 i''',J r r 1)! r II l. ' '. o L 1t I .. . ` { .'+'''',..`,:''
1 A. Fee for branch circuits with
'en ._� r: M i I . F I. :1 t ,..: r. Yi lr
... , • l ,, A �V service or feeder fee, each j 6.65 �.aor 2
Business name: branch circuit ( , r -
^ B. Fee for branch circuits •
Contact name. • wtthota service or feeder fee,
each branch circuit 46.85 2 • Address: Each add'l branch circuit 6.65 f 2
•
City/State/Z.11 14Tiscellaacods (service nr feeder not included)
Phone: ( ) ' Fax: ; ( ) • Pump or Pump circle 53.40 ' _ 2
• Sign or outline lighting 53.40 2
B -mail: Signal circuit(,) or limited- '
i ;':i' i 7 , rr J 7: _ _ ir k..' ' - $ I , ri tc l,_ „ . e,l Iii J al i• .‘_/-.1: E,,-. 4? ' Y r1 . �Lti ri';. 1 0 1 l '.i energy panel, alteration, or
Business name: extension. Describe: Page 2 2
Address: - 2,6 . Si) i' i ('I 1 'ell At- e , - A 4 Each additional Inspection over allowable in any of the above
! 1 per inspection 62.50
City/ State/ZIP:
j k ) U 0 C) R i 3 Investigation per hour (t le tin) 62.50
Phone: ( )) ( - 1 L { � j � � 7 3 . 7 5
16. :- L:'� ' .7,..�r. � 1-1 � .L� .:�:r •. e�-
CCS Lie.: '� l ( Electrical Lic.: LEA• / subtotal ; ., g
Suprv. Electrician signature, required: %Wl';/ ' _ Plan review (25% of permit fee)
Print name: 44\3 l .-. `� Date: Mil State surcharge (8% of permit fee) . e 15 .--"'
Authorized signature: )P IT FEE J 3 ,,. j 0
Signature: Tai. per mit app erpireo If a permit is cot obtained within 180
days after it bas been accepted at complete
Print name: Date: • Pee methodology set by Tr- Comity Building industry Service Board
. ' •'r Number of inspecdona per permit allmwed.
cBuildng\pamidun.C.PsnIApp.dnc 17103 440- 46IST(10/OVCOMfWSB •
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: "(303) 639 -4175
INSPECTION DIVISION Busine *s Line: (503) 639 -4171 MST
BUP
Received Date Requested AM PM BUP
Location / 303"5" Suite MEC
Contact Person Ph ( ) PLM
Contractor & 6c•Ec472+c— ^�f Ph ( ) 6y8 «5 2 - SWR
BUILDING Tenant/Owner ELC
Footing ELC ?—c y — " 5 Od
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation .r ;`
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
Rough -In
UG/Slab
Low Voltage
F'= •rm
Fin • Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. •
PART FAIL
❑ Please call for reinspection RE: Unable to inspect — no access 4 Fire Supply Line ✓ �_ � '/ M _n M Le zf � V
ADA Approach/Sidewalk Date 1 / Inspector Ext
Other: •
Final DO NOT REMOVE this inspection record from the job site. -
PASS PART FAIL