Permit - J-1 CITY OF TIGARD
COMMUNITY DEVELOPMENT ELECTRICAL PERMIT
PERMIT #: ELC2007 -00072
D ATE ISSUED: 1/29/2007
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2 S 102 C C -0110 0
SITE ADDRESS: 13680 SW PACIFIC HWY ZONING: C -G
SUBDIVISION: LOT : JURISDICTION: TIG
Project Description: Electrical service for new collocation. Job No. 12352
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: 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 NO. 207 OREGON ELECTRIC GROUP
13680 SW PACIFIC HWY 1010 SE 11TH AVE
TIGARD, OR 97223 PORTLAND, OR 97214
Phone: Contact #: FAX 503 - 535 - 2763
PRI 503 - 234 -9900
FEES
Description Date Amount Reg #: ELE 26 -95C
[ELPRMT] ELC Permit 1/29/2007 $80.30 LIC 203
[TAX] 8% State Surcharge 1/29/2007 $6.42 SUP 4460S
Total $86.72 REQUIRED ITEMS AND REPORTS
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 r are •rth in O- t 9 - 001 -0010 through OAR 952 -001 -0100. You may obtain copies of these rules or direct questions to OUNC at
503.2 -.6699 or 1 .800. -3 . , .
Issu _ d By: k , / t / /' 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:
ONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 503.639.4175 by 7:00 a.m. for an inspection that 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.
JAN -24 -2007 06:43PM FROM -OR ELECTRIC SVC 5035352763 T -891 P.007 /010 F -468
.. rte e tCal rermit Application ,
CR of Tigard r _ n e A 0 7 r re
noway: e 7-Da 72,
tY 1P� �
13125 SW Hall Blvd., Tigard, 0 Zr V Phu Review
CAW petrutit;
Phone: 503.639.4171 Fax: 5011598% 1)6 `' . l''' Date/By N MP O 7 �O�/
p%1 w r ® Sec Z for
Inspection Lite : 503.639.4175 _ I Me Ready /BY
Internet www.ci,tigard.or.lus . l 2 Not111m/Mttbod / ( Y� _ supplements') taformatlon
1--- TYPE 0/;04114.,.., jv��e'�y PLAN REVIEW
i.
® New construction ❑ 01113 oeffffl�daf 1 Please cheek all that apply:
❑ Demolition �ce um
❑S over 225 amps, con'l ['Hazardous location
❑ Service over 320 amps - rating El Bulking over 1 0,000 cc!, it,
• CATE ) Y OF C of 1- and 2- family dwellings 4 or more new residential
❑ 1- and 2- family dwelling El Commercial/industrial ❑ Accessory building ❑ System over 600 volts nominal units in one stnUCNIC
['Building over three storiac ❑Fcedera, 400 amps or more
❑ Multi- family
❑ Master builder ❑ Other, ❑ Occupant load over 99 persons OManu fictured structures or
JOB SiTE INFORMATION AND LOCATION ❑F- gress/tightiagplun RV park
Job no.: 12352 Job site address: 13680 PACIFIC HWY ❑Hedth facility ❑Other. -
Submit 2 sets of plans with any of the above.
City / State/ZIP: TIGARD, OR 97223 The above are not applictblo to temtmtary construction service.
•
Suite/bldg./apt. no.: I Project name: CLEARWIRE CELL TOWER FEE' SCHEDULE
neserlpdm 1 Qty. I roe. I Total I -.
Cross street/directions to job site: MIGHT BE SLIGHTLY ISOLATED New residential single- or multi- family dwelling unit.
Includes attached garage.
BEWTEEN SW GARRETT & SW MCDONALD ON PACIFIC HWY 1,000 sq. ft. or less 145.15 4
Subdivision: i Lot no.: Es. add'l 500 sq. R. or portion 33.40 I
Limited energy, residential 75.00 2
re
TeX ap /parcel no.: _Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
•
POWER TO NEW CELL TOWER _dwelling, scrvicc feeder and/or der 90.90 2
Services or feeders installation, alteration. and/o_r relocation
200 amps or less I 80.30 2 _
❑ PROPERTY OWNER 0 TENANT 301 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: S - -7 , Lo7:4 , , £17 601 amps to 1,000 amps 240,60 2 -
Address: 44,g0 0 1.0 Aid jitirvf Over 1,000 amps or volts 454.65 2
Rsconncet only 66.85 2
City/ Statc/ZIP: � f t" O/L 97 A 2,5 Temporary services or feeders installation, alteration, and /or
Phone: ( ) • I Fax: ( ) relocation
200 amps or less 66.85 I
Owner installation: This installation is being made on property that I own which is Rot 201 amp,- to 400 amps 10030 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 1 ❑ CONTACT PERSON A. Lee for breech circuits with
service or feeder fee, each 6.65 2
Business name: branch circuit .
13. Fee for branch circuits
Contact name: without service or feeder fee,
each branch circuit 46.85 2
Address:
Each WW1 branch circuit 6.65 2
City/ State/ZIP: Miscellaneous (service or feeder not included)
Phone: ( ) `Fax:: ( ) Pump or irrigation circle 53.40 2
_ S ign or outline lighting 53.40
E-mail: _ Signal cmcuiga) or limited -
CONTRACTOR energy panel, alteration, or
extension. Describe: Pagc2 2
Business name: Oregon Electric Group
Address: 1010 SE 11th Ave Each additional inspection over allowable in any of the above
Per inspection 62.50
City / State/ZIP: Portland, OR 97214 investigation per hour (1 hr min) 62.50
Phone: (503) 234-9900 [Fax: (503) 535 - 2763 Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES"
CCB Lic.: 203 I Electrical Lic.: ' ■ S .. Lic.: 4460S Subtotal go. 3 0
Suprv. Electrician signature, required
Plan review (25% of permit Coe)
Print name: i 0 . ,_ m . 0 '`ir State surcharge (8% of permit fee) to , a _
` 1
�J • 1 I . �_-
TOTAL PERMIT FEE go , / 6
Authorized signature: i L A / Thus permit application expires If a permit le not obtained within 180
Lam` / r' days Mier It has been accepted as compicic
Print name: V Ir' a A Al , /- P ter: I /24/07 / • Number of inspections per permit allowed.
methodology set byTri- Ceinuy Building Industry Service Board •
I;enulltamPenniaTLCBamitApp.dec 12103 Ae046i37( IAMB
0t_ IsStac yze& ?I � . et-r V'Lbt6}
CITY OF TIGA
BUILDING DIVISION PERMIT #: ELC2007 -00072
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/29/2007
Phone: (503) 639 -4171 n ICI
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 3/8/2007 TIME: 7:01AM PAGE: 13
SITE ADDRESS: 13680 SW PACIFIC HWY CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: CLEARWIRE
DESCRIPTION: Electrical service for new collocation. Job No. 12352
OWNER: TIGARD LODGE NO. 207, PHONE #:
CONTRACTOR: OREGON ELECTRIC GROUP PHONE #: 503 - 234.9900
Inspection Request Scheduled For: Date: 3/8 /2007 Pour Time:
Code # Inspection Description --Gorrfirm # Contact # Message
115 Electrical service 044523 -02 503 - 849 -3291 "
Corrections /Comments /Instructions:
COO b
N( 5 Mir i s �—� p t
❑ PASS ❑ PARTIAL APPROVAL ►'/ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: "'V Date: 3 s o l Phone #: (503) 718 - ALA9'
CITY OF TI,3A RD
BUILDING DIVISION PERMIT #: ELC2007 -00072
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/29/2007
Phone: (503) 639-4171, .1 :11y I I
Inspection Requests (24 Hrs.): (503) 639 -4175 `'..
INSPECTION WORKSHEET FOR DATE: 3/2212007 TIME: 7:00AM PAGE: 31
SITE ADDRESS: 13680 SW PACIFIC HWY CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: CLEARWIRE
DESCRIPTION: Electrical service for new collocation. Job No. 12352
OWNER: TIGARD LODGE NO. 207, PHONE #:
CONTRACTOR: OREGON ELECTRIC GROUP PHONE #: 503 - 234 - 9900
Inspection Request Scheduled For: Date: 3/22/2007 Pour Time:
Code # Inspection Description onfirm #. Contact # Message
115 Electrical service 045243 -01 503. 849.3291 Y
C
Corrections /Comments /Instructions:
4 # 1* *Izettv . W\ INXVisA LENCi10) F tookia6(6 b
I S a oL) 4 Lo •
?R.cY•11 6 coal4460- fat. Ute•
U
OAk °1 t1 xXX . KKX
❑ PASS XPARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL XCALL FOR INSPECTION ADDITIONAL FEES ASSESSED
Inspector: • 68L6' Date: 3- Phone #: (503) 718- 2•`fVo
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2007 -00072
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/2912007
Phone: (503) 639-4171 +�
Inspection Requests (24 Hrs.): (503) 639 -4175 r'L �I
INSPECTION WORKSHEET FOR DATE: 7/20/2007 TIME: 7:03AM PAGE: 65
SITE ADDRESS: 13680 SW PACIFIC HWY CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: CLEARWIRE
DESCRIPTION: Electrical service for new collocation. Job No. 12352
OWNER: TIGARD LODGE NO. 207, PHONE #:
CONTRACTOR: OREGON ELECTRIC GROUP Ly PHONE #: 503-234-9900
Inspection Request Scheduled For: Date: 7/20/2007 Pour Time:
Code # Inspection Description # Contact # Message
199 Electrical final 052402 -01 503 - 8433291 Y
Corrections /Comments /Instructions: E ISO
P ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
C I -- Inspector: � t '3 Date: #_\__6,ZS Phone #: (503) 718- `