Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2005 -00140
Yf� DEVELOPMENT SERVICES DATE ISSUED: 3/9/2005
"- I— 13125 SW Hall Blvd.. Tigard. OR 97223 (503) 639 -4171
PARCEL: 2S 102CC -01100
SITE ADDRESS: 13680 SW PACIFIC HWY
SUBDIVISION: ZONING: C -G
BLOCK: LOT : JURISDICTION: TIG
Project Description: Install 200 amp service to cell equipment.
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: 2 W /SERVICE OR FEEDER: 6 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 LODGE #207 WESTOWER COMMUNICATIONS INC
PO BOX 230184 19500 SW CIPOLE RD
TIGARD, OR 97281 TUALATIN, OR 97062
Phone: 503 - 625 -4084 Phone: 503 - 210 -1000
FEES Reg #: ELE 34 -676C
tion Date Amount LIP 140471
Description SUP 4140S
[ELPRMT] ELC Permit 3/9/2005 $200.50
[TAX] 8% State Surcharge 3/9/2005 $16.04 REQUIRED ITEMS AND REPORTS
Total $216.54
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 -2
Issued By: Permittee 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:
CONTRACTO; • - - • = ON ONLY
� /c r /o
SIGNATURE OF SUPR. ELEC'N: CJ _ DATE:
LICENSE NO: �l O C
Call 639 -4175 by 7:00pm for an inspection the next business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Electrical Perniai�><on FOR OFFICE USE ONLY
Received
City of Tigard 0 9 1005 DateByj -- - 05 - X2 Permit No.: L �,c/ ad/ 0
13125 SW Hall Blvd., Tigard, OR 1 %% Plan Review
Phone: 503.639.4171 Fax: 503.5 8.1960 AR � / ip other Permit:
! �+v i ill` Date/By: Re
Inspection Line: 503.639.4175 ,.„...„0 OF 'DV ,r.� 6• Date Ready/By: 3 ® See Page 2 for
Internet: www.ci.tigard.or.us C11 1 �
T�Ii�'IV - Notified/Method: J 1 Supplemental Information
BUI L� jj ��`` YP E G OF WORK f PLAN REVIEW
® New construction ❑ Addition /alteration/replacement Please check all that apply:
❑ Demolition ❑Other: ❑Service over 225 amps, comm'l ❑Hazardous location
❑Service over 320 amps - rating ❑ Buildng 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 ❑Egress/lighting RV park
Job no.: 63 -10328 Job site address: 13680 SW Pacific Hwy ❑Health -care facility ❑Other:
Submit 2 sets of plans with any of the above.
City/State /ZIP: Tigard, OR 97281 The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: Project name: Sprint co- locate FEE* SCHEDULE
Description I Qty. I Fee. I Total I ••
Cross street/directions to job site: SW Pacific Hwy 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'] 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
Install new 200 amp service to Sprint cell equipment dwelling, service and /or feeder 90.90 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 2._ 80.30 / G 0.0 2
® PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: Tigard Lodge #207 601 amps to 1,000 amps 240.60 2
Address: PO Box 230184 Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/State /ZIP: Tigard, OR. 97281 Temporary services or feeders installation, alteration, and/or
Phone: (503)625 - 4084 Fax: ( ) relocation -
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
❑ APPLICANT I ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each 6.65 r f v 2
Business name: branch circuit PPP777
B. Fee for branch circuits
Contact name: without service or feeder fee,
each branch circuit 46.85 2
Address: Each add'] branch circuit 6.65 2
City/State /ZIP: Miscellaneous (service or feeder not included)
Phone: ( ) F es:: ( ) Pump or irrigation circle 53.40 2
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: Westower Communications Inc
Address: 19500 SW Cipole RD Each additional inspection over allowable in any of the above
Per inspection 62.50
City/State /ZIP: Tualatin, OR 97062 Investigation per hour (1 hr min) 62.50
Phone: (503) 210 -1000 Fax: (503) 210 -1001 Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
CCB Lic.: 140471 Electrical Lic.: 34 -676C Suprv. Lic.: 4140S Subtotal . 2 0 0 , SO
Suprv. Electrician signature, required: .6g 0 Plan review (25% of permit fee)
Print name: A 4,,,L�y S 7 - 2 t di p° Date: 3/710 S State surcharge (8% of permit fee) 6 •� CI
TOTAL PERMIT FEE 2/6, S L!'
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
•• Number of inspections per permit allowed.
i:\ Building \Pemdts\ELC- PcrmtApp.doc 12/03 440- 4615T(10 /02/COM/WEB
CITY OF TIGARD _ .. ,
BUILDING DIVISION PERMIT #: ELC2005 -00140
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/9/2005
Phone: (503) 639 -4171 Vi�l�
Inspection Requests (24 Hrs.): (503) 639 -4175 -_..
INSPECTION WORKSHEET FOR DATE: 3/25/2005 TIME: 7:07AM PAGE: 112
', SITE ADDRESS: 13680 SW PACIFIC HWY CLASS OF WORK:
1 SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: SPRINT
DESCRIPTION: Install 200 amp service to cell equipment.
OWNER: TIGARD LODGE #207, PHONE #: 503 - 625 -4084
CONTRACTOR: WESTOWER COMMUNICATIONS INC PHONE #: 503 -210 -1000
Inspection Request Scheduled For: Date: 3/25/2005 • Pour Time:
Code # Inspection Description Confirm # Contact # Message
115 Electrical service/reconnect 002768 -01 503 -969 -2956 N
Corrections /Comments/ Instructions:
C I ,
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: D at e: Phone #: 503 P ( ) 718-