Permit A :,.. CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00256
,.i.. DEVELOPMENT SERVICES DATE ISSUED: 5/13/2004
Jul,-,I, ,L '� I � 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S 110DC -02200
SITE ADDRESS: 15532 SW PACIFIC HWY C -5
SUBDIVISION: WILLOW BROOK FARM ZONING. C -G
BLOCK: LOT : 011 JURISDICTION: TIG
Project Description: (2) branch circuits for additional lighting.
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: 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: 1 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, CENTER LP LEON DOJA ELECTRIC
9777 WILSHIRE BLVD #609 530 NE 152ND AVE
BEVERLY HILL, CA 90212 PORTLAND, OR 97230
Phone: Phone: 503 - 260 - 6555
Reg #: ELE 26 -1078C
LIC 143778
FEES SUP 4644S .
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 5/13/2004 $53.50
[TAX] 8% State Surcharge 5/13/2004 $4.28 Rough -in
Elect'l Final
Total $57.78
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 a re orth in • ' - 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questio s to OUNC at (503)
246-0 9 or 1 X00- 332 -2 44. ii . cal:
Issu d By: y , �! - / Permit Signature: r
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: o /��- DATE:
LICENSE NO: 4/6 i q 5
Call 639 -4175 by 7:00pm for an inspection the next business day
Electrical Permit Application FOR OFFICE USE ONLY
Received —ori n a- --/
' Received 4 eel Pemtit \o.:eG aCf (O
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 I Date'Bv: Other Permit:
Inspection Line: 503.639.4175 r` '
City 4 Tigard S
Date Ready /'By: to a See Page 2 for
Internet: www.ci.tigard.or.us Notified Method: A a Supplemental Information
TYPE OF WORK 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. It,.
CATEGORY OF CONSTRUCTION of I- and 2- family dwellings 4 or more nett residential
❑ I and 2 family dwelling ❑ Commercial /industrial ❑ Accessory building ❑System, over 600 volts nominal units in one structure
❑Building over three stories C] Feeders, 400 amps or more
❑ Multi family 0 Master builder 0 Other:
❑Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION C— S ❑Egress /lighting plan RV park
Job no.: Job site address: 5` ' a / ^ ❑Flealth -care facility ['Other: 7 3 1. �a 4 N �' H (,t, mit 2 sets of plans with any of the above.
City /State /ZIP: 4- t„ / h I O e above are not applicable to temporary construction service 1
Suite /bldg. /apt. no.: Project name: l FEE* SCHEDULE
Description Qty. I Fee. '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 I
Tax map /parcel no.: Limited energy, residential 75.00
Limited energy, non - residential 75.00
DESCRIPTION OF WORK Each manufactured or modular
/�
_/ f A , , G f l �I
t k c hnr dwelling, service and /or feeder 90.90 2
4 �I QI �vV
`� ` � n �. k e � ` Services or feeders instatlation, alteration, and/or relocation
200 amps or less 80.30 '_
❑ PROPERTY OWNER I I ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 I 2
601 amps to 1,000 amps 240.60
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
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
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75
Owner signature: Date: Branch circuits - new, alteration. or extension, per panel
❑ APPLICANT ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each
6.65 2
Business name: branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee,
46.85 iG .Q� 2
Address: each branch circuit
Each add'I branch circuit i 6.65 6.`7 2
City /State /ZIP: Miscellaneous (service or feeder not included)
Phone: ( ) Fax:: ( ) Pump or irrigation circle 53.40 2
Sign or outline lighting 53.40 -'
E - mail: Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or
Business name: L Q CL,2 C / • C 1,-,ro extension. Describe: Page 2
Address: SZ NF 1 C, N O "V l� Each additional inspection over allowable in am of the above
7 Per inspection 62.50 i
City /State /ZIP: A2_Thil .. Qlk ' f C f . 3 - X - . 1 0 Investigation per hour (I hr nun) 62.50
�\ 03) 6O 6SSs Fax: ( ) io((ifn`l Industrial plant per hour 73.75
� r ELECTRICAL PERMIT FEES*
k CCB Lie.: j( 5 13 '/ 8 t Electrical Lic.. — i 0-78c Suprv. Li l (14 J Subtotal ,F,Q, 5 d
/1
Suprv. Electrician signature, required: 1 Plan review (25% of permit fee)
JJ
State surcharge (8% of permit tee) �. a Q i
Print name: LEON �I� �— Da e: 3 —o TOTAL PERMIT FEE 1�7. ��
Authorized signature: V This permit application expires if a permit is not obtained ,siii in ISO
days after it has been accepted as complete
Print name: Date: • Fee methodology set by Tri- County Building Industry Ser ice Board
•• Number of inspections per permit allowed.
1 Building' Permits,ELC- PermitAppdoc 1103 440.40 15T110E02CO>1 WEB
Electrical Permit Application - City of Tigard
•
Page 2 - Supplemental Information �.
LIMITED ENERGY PERMIT FEES:
•
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ . Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
•
❑ Other
•
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
i.\ Building \Permits \ELC•PermuApp,doc 04/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Lhle: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested — < < PM BUP
Location / V Suite C- - MEC
Contact Person Ph ( ) Sl ! - O 5 D(o PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner a_/ , , F" `'! ELC / S - ,
Footing
Foundation ELC
Access:
Ftg Drain
ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam /11 _4
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
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
Fire Alarm
❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
S ❑ Please call for reinspection RE: ❑ Unable to inspect - no access
Fire Supply Line I t� /) Kl l/� 6,1,�n�I/ ADA Date N 1 ✓ v Ins or ( Al. ' ! rem 66 Y.
Approach/Sidewalk pew
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL