12215 SW MAIN STREET-1 NO 133b1S NIVW MS
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12215 SW MAIN ST STE 120
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CITY OF TIGARD ELECTRICAL PERMIT
PERMIT 0: ELC2004-00007
DEVELO"'IMENT SERVICES DATE ISSUED: 1/9/04
13125 St', r all Blvd.,Tigard, OR 97223 (503) 639-4171 PARCEL: 2S102AA-05500
SITE ADDRESS: 12215 SW MAIN ST 120
SUBDIVISION: KINGSTON ZONING: CBD
BLOCK: LOT: 017 JURISDICTION: 'rlG
Project Description: Add Fo bpanel and rewire of(8)branch circuits.
RESIDENTIAL UNIT TEMP SRVC/FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: i PUMP/IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN/OUT LINE LTG:
LIMITEC ENERGY: 401 - 600 amp- SIGNAL/PANEL:
MANF NMI SVC/FDR: 601+amps-1000 volts: MINOR LABEL (10):
SERVICE/FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: 1 WISERVICE OR FEEDER: 8 PER INSPECTION:
201 - 400 amp: Ist 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:
TIMOTHY ZELLER STEELHEAD ELECTRIC INC
12215 SW MAIN ST 207 JERSEY ST
TIGARD,OR 97223 SILVER70N,OR 97381
Phone: 503-639-1635 Phone: 503-873-4496
Reg#: 1-W 135010
FEES ELI. 24-419C
SUP 4821S
Description Date Amount
Required Inapecrlons
(ELPRMT] ELC Permit 1!9/04 $.33.50
j'rnX18%State Surcharge 1/9/04 $10.68 Elect'IService
Rough in
Total $144.18 Elect'[Final
This Permit is issued subject to the regulations contained in the Tigard Municipal Code,State of OR.Specialty Codes and all of r applicable laws. AN
work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of i uance, r if work is suspended
for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Nottficat Ce er. Those rules are set
forth in OAR 952-001-0010 through OAR 952-001-0100. You may obtain copies of these rules or directuestions o U at(503)246-6699 or
1-800-332-2344.
fiL—, Issued BY: CC�iC�l Lb/:�C Permit Signature:
H
OWMER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
J_
_m OWNER'S SIGNATURE: DATE:
W
–t CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: AJ "
1 L �_ DATE:
LICENSE NO: zg,2z S
Call 639-4175 by 7:00pm for an Inspection the next business day
1
Eleciftal Permit Application
W
City of Tigard Received ./ Pemtit No.
13125 SW hall[31vd.,"figard,OR 97223 Daly / 9 e7 j -�ADGl�7
t Plan Review 01he,Pemtit.
Phone: 503.63'1.4171 Fax: 503.598.196(1 t�aaiBy:
1,spection Line: 503.639.4175 Date Ready/By Jur ® See Page 2 for
'emet www.ci.tigard.or.us Notified/Method: /!6 Supplemental Information
TYPE OF WORK PLAN REVIEW
❑New construction lddition/alteration/replacement Please check all that apply:
❑Service over 225 amps,comm'I [I i lazardous location
❑Demolition [j Other: — ❑Service over 320 amps-rating ❑Bui:Cl'rg over 10.000 sq.it.,
CATEGORY OF CONSTRUCTION of I-and 2-family dwellings 4 or more new residential
❑ I-and 2-family dwelling (�Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑ Multi-familv ❑Master builder []Other: ❑Building over three stories []Feeders,400 amps:tr more
❑Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress/hgllnng plan RV park
❑Health-carr.facility ❑Other:
Job no.: Job site address: � Z 2- j `e J a�w Submit 7 set,of plans with any of the nhnve. ~�
City/State/ZIP: y ) 2•u The about,are nA applicable to tenrtorary construction service
_
Suitc/bFEE' SCHEDULEldg./apt.no.: Project name: /�/�]��pp ������
_-- �_l..d1fL/�'L� G:.erlpuon Qty. Fee. Tool
I --
Cross street/directions to job site: `��tGiL� New reincie lal single-or multi-family dwelling unit.
- Includes attached garage.
1,000 sq.R.or less 145.15 4
Subdivision: - —i Lot no.: Ea.add'I 500 sq.ft.or portion _- 13.40 1
Tax map/parcel no.: Limited energy,residential 75.1)3 2
Limited energy,non-residential /5.00 2
DESCRIPTION OF WORK Each manufar(ured or modular
nn /
dwelling,service and/or feeder 90.9n 2
L 4�)'Vl �_— Services or feeders Installation,alteration,and/or relocation
200 amps or lest _ 80.30 VD,3C t 2
201 amps to 400 amps _ 1(16.85 2
❑ PROPERTY OWNER r� �/J/�TENANT _ 401 amps to 600 amps _ 160.60 2
Name 2 e? J�.!} «r.���1� S� 601 amps to 1,000arrps_ 240.60 2
Addr•9s: Over 1,000 1,000 amps or volts 454.65 2
'22.Z3 Reconnect only _ 1 66.85 _ 2
City/State'?IP: �,.,. J1 Temporary services or feeders installation,alteration,sudor
Phone:(� —)� �� Fax:( ) relocation
�' 70 ' yj Z/ 200 amps or less 66.85 I
Owner installation:This installation is being made on property that 1 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
ffi�APPLICANT ❑ CONTACT PERSON A.Fee for branch circuits with
/' service or feeder fee,each 665 2
Business name: / branch circuit
- --�w S.Fee for branch circuits
Contact name: without Rervice or feeder fee,
each branch circuit 46.85 1.
Address: Z Each add'I branch circuit 6.65 2
City/State/ZIP: Z L Miscellaneous(service or feeder not Included)
CL Phone: Fax: :(Sj�3 ) S/ 7 l G Pump 1)r 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: e 2 2
J hPagBusiness name: ��� L l t� 7Z?t e j,Ue ,
ra Address:
Baon over allowable� ch additional Inspection In any of the above
, -- _
0 Z � Jy.2 S E Y � Per inspection 62.50
JCity/State/ZIP: t 'e T2^i,-, c,d- �7 3 T I Investigation per hour,1 hr min) ;��
Phone:(�j ) �� rFax: Sr 3 Industrial plan!per hour llJF � 87 3 /c//V ELECTRIC iw YE
ClB Lic1� Electrical Lic.: �r Suptv. Lic.: 1�2( S Subtotal
Suprv.Electric-an signature,required: /e i t y Plan review(25%of permit fee) /e,
"tate surcharge(8%of permit fee)
Print name: J f� S`� 7 N Date: / _ pY TOTAL PFRMIT FEE
Authorized signature: This p:rmit application expires Its permit is not obtained within 180
days after It has been accep'ed as complete
Print name: Date: /)t,< • Fera methodology set by Tri-County Build;ng Industry Service Board
�— ••Number of inspections per permit allowed.
i\Building\Permira\ELC-PermitAppdoc 12103 440-4615r(loWCOMMTI'l
Electrical Permit. Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENne WORK QNI Y:
Fee for all residential sy stems combined........ $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
L Garage Door Opener*
j] Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
❑ Other:
Fee for each commercial system....................... $75.00
(SEE OAR 918.260-260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
Moiler Controls
❑ Clock Systems
❑ Data Telecommunication Installption
❑ Fire Alarm Installation
[1 HVAC
❑ Instrumentation
CL ❑ Intercom and Paging Systems
U) ❑ Landscape Irrigation Control*
❑ Medical
m
a ❑ Nurse Calls
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❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
i\Btd1dinp\PennftsTI.0 PttmitAPp dm M/03
CITY OF TIGARD 24-Hour I
BUILDING Inspection Line: (503)639.4175
INSPECTION DIVISION Buainess Lifte: ' (903)639-4171 MST _
BUP '
Received ? Date Requested �^�/���AM PM_ __ BUP _.
LocationSuite _ MEC
Contact Person = Phi_------) PLM —
1' Contractor—v �� � '�' Z� � Ph SWR
►r r BUILDING Tenant/Owner _—_ EL
Footing
Foundation Access: ELC —
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post&Beam
Shear Anchors
Ext Sheath/Shear _
Int Sheath/Shear
Framing -- --- — —_..— _
Insulation
Drywall Nailing - -- -
Firewall
Fire Sprinkler -- --- — -----
Fire Alarm
Susp'd Ceiling ------
Roof
Other: _ -- ----_� —_Final
PASS
PASS PART FAIL
PLUMBING
boat& Beam
Under Slab -- ---
Rough-In
Water Servica ---- — -- ----
Sanitary Sewe,
Rain Drains - — - —
Catch Basin/Manhole
Storm Drain —
Shower Pan
Other:
Final
PASS PART FAIL —
MECHANICAL —.
Post& Beam
Rough-In - ---- —
a Gas Line
Smcke Dampers - — -- —
Final
PASS PART FAIL —
ELECTRICAL ---
-_� Service
OD Rough-In
u UG/Slab �^
J Low Voltage
97PART
Fi l] Reinspection fee of$ required before next inspection. Pay at City Hall, 13125 SW HAII Blvd.
FAIL
SITE [] Please call for reinspection RE: — F] Unable to inspect-no access
Fire Supply Ling i
ADA y
Approac'JSidewalk D 111 —Elft
Other:
Final s-- DO NOT REMOVE this Inspection record fin the job Its.
PASS PART FAIL /
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