Permit •
4 CITY OF TIGARD ELECTRICAL PERMIT
II
`° ': COMMUNITY DEVELOPMENT Permit #: ELC2009 -00644
T [GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 12/03/2009
Parcel: 1S134BD00100
Jurisdiction: Tigard
Site address: 10650 SW 121ST AVE 24
Subdivision: WESTWOOD GREEN APARTMENTS Lot: 0
Project: Westwood Green Apartments
Project Description: Reconnect.
Owner: FEES
GARDNER FAMILY PROPERTIES LLC Quantity Description Date Amount
15315 SW ALDERBROOK DR
TIGARD, OR 97224 1 ea Reconnect Only 12/03/2009 $67.84
PHONE: 1 ea 12% State Surcharge - 12/03/2009 $8.14
Electrical
Contractor:
SQUIRES ELECTRIC
PO BOX 16851
PORTLAND, OR 97292
PHONE: 503 - 252 -1609
FAX: 503 - 253 -5831
Type of Use: MF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $75.98
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. 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 the 180
days. ATTENTION: Oregon law requires you to follow the 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 a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: (R r lx l ikk >`-' 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:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' o Date:
LICENSE NO.
CaII 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.
r 1 E C t I v , y Electrical Permit Alication r ' � ; ` j > k { A te ° Felz �a, r . o� ��� i c y .� Y ',
0 ,() Permit No.:
D C l ' tCZOo4 ` I e '1/ 13125 SW Hall Blvd., Tigard OR 97223 n 'zoo �) p lan Review -
• � ' - p , _ II : Phone: 503.639,4171 Fax 503.598.1960 Date/13v: Other Permit:
f i G - R D Inspection Zinc. 503.639.4175 CIE _' O:,- E i o a . i DDate Ready/By: See Page 2 for
.. • Internet: www.tigardor.gov a r,1 i - Notified/Method: I 1 C Supplements! lnfonttatlon
PI 4.,—,v .:, , y . TM ar_ .74rrt -v'-c� #. ,.. rq' n± ,' ."i ft _� a.c yr. ti� p .... 7 .` 5,
F`.£�r� ` ; ( 7 - n61 , ,,,.,1':°R.S iiYA' ate=' ,,,: ,,:'., 2 .KC r:. x.,: � ' A A .,.. o r....;.„ • (' . r', '44 .,. . , 'r ..�, .4r, WA
❑ New construction 1.(1 Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w/itcms checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
0 Demolition ❑ Other: whet* the available fault current ❑ Marinas and bo. ty'ards.
buiidi.
t ?z� s
, '' Y -~ ; :1' f -,77 r �, 7 'T #r '`�l '' 4 s :; y exceeds 10,000 amps at 150 whs or ❑ Flowing ��s
a ■ <a'- 1-z ,, less to ground, or exceeds 14,000 ❑ Commercial -we agricultural
❑ 1- and 2- family dwelling ❑ commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi-family 17 Master builder ❑ Othcr: ['Fire pump. ❑ Installation of 75 KVA or
r.3 ' •� 'e"�' Art- 4 , -7 4 , , , , , .4 q> { i BF to r ' ,w d , p ❑ Etncr s larger separately derived system.
,},ma �" ♦ ��p . iR . . :. A. - 4,,,„c yi ._ ,t !t t'f pi; ., ❑ Add of new motor load of ❑ ..A ", `:E "1 -2" "1."
Job no.: Job site address: /01, 66 00 % g 1. Ale. . looxp or *lore. occrrpaaoy.
❑ Six R more residential units. ❑ Recreational vehicle panes,
City /StateIZIP: Q % ❑ Health -care facilities.
El Supply voltage for more than
_ ❑ Ha ardour locations. 600 colts nominal.
Suite/bldg. /apt, no.: Project name: �t2 _ ❑ Service or feeder 600 amps or more
Cross street/directions to job site: rtcscription Qtr, Fa. *oat -
New residential single or multi - family dwelling unit
Includes attached garage- _
Subdivision: Lot no.: 1,000 sq_ ft. or less 168.54 4 -
_
Ea. add'l 500 sq, ft. or portion 33.92 1
s Tax map /parcel no _ imited energy, residential
tlrrj'J{ . ,1i .&r r . e C 3 M L
,Ay,.t. � , ... : ,- r �, A 4,, .,c „ T r I ,+V v. ,fi'� « r P n .5. (with above sq. ft.) 67.84 2
1'
Re fir Limited energy, multi - family 67.84 2
Ke ' E -m4-q i Z e k6.e.ra / 4-' e_ Q Y re, residential (with above sq. ft.)
— Services or feeders installation, alteration, and/or relocati • n
200 amps or less 100.70 f; i ,r 2
1 fM < a t `r c u w k i k - Ilm ::r , t 1 , a 2c " 7 - r c c.. . 201 amps to 400 amps 133.56 2
":.,t-- .�..n -Jr, d. � , .� .�.. .;� SV ~ .cr -? `eli:w°�..o-hu� a'�,.1 +k�cf;?l0rt P A _
Name: 401 amps to 600 amps 200.34 2
-• 601 amps to 1,000 amps 301.04 - 2
Address: Over 1,000 amps or volts 55226 2
City/State/ZIP: relocation ry services or feeders installation, alteration, and/or
`
Phone: ( ) Fax: ( ) 200 amps or Icss 59.36 1
Owner installation: This installation is being trade on property that 1 own which is not 201 amps to 400 amps 125.08_ • 2
j intended for salt, lease, rent, or exchange, according to OILS 447, 449, 670, and 701. 401 amps to 599 amps 168.54_ 2
Branch circuits - new, alteration, or extension, • • r panel
Owner signature: Date: A. Pee for branch circuits with
; ^ s WWI A77 r7 * J c r . " . i "fix . , . o r ' t; !'t r,). , , above service or feeder fee,
7.42 2
each branch circuit
Business name: B. Fee for branch circuits
i — without service or feeder fee,
I Contact name: first branch circuit 56.18 2
Address: Each add branch circuit 7.42 2
Miscellaneous ( senice or feeder not included)
1 City /State/ZIP: Each manufactured or modular
dwelling, service and/or feeder 67.84 2 _
Phone: ( ) Fax: : ( ) Reconnect only 1 67.84 G- 2
E -mail: Pump or irrigation circle 67.84 2
Elf r -^r -• - t �. �^ rzmw.. o . F Ci"•'t` lighting SS�� c , ^ r secs ? h °cs••� `rrt ri Sign or outline li ring 67.84 2
Business name: „ Al- , 1 S
w rew i ' Signal circuit(s) or limited-
_. -- e ner gy panel, alteration, or
Address: 76 /4 gr i extension. Describe: Page 2 2
City /Statc/ZIP: ?a,rk, Cat_, 97.=.1-9- Each additional inspection over allowable hi any of the above
Per inspection 66.25
Phone: ( ) o 1 -11,69 Fax: ( ) ,:26.3'5a3/ Investigation per hour (1 hr rein) 66.25
CCB Lic_: /, I Electrical Lic j6 -110/ e Suprv. Lic.: e�� ..6 Industrial plant per hour 78.18
Suprv. Electrician Signature, requir�i r _ Subtotal: O
( �y} Date: Plan review (25% of permit fee):
Print name: - -
�k e- �d ✓�` I ` >� State surcharge (12% of permit fee): /.. • l� Q
Authorized signature: TOTAL PERMIT FEE: /�1�j 1
Thix permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
- - • • Number of inspections allowed per permit.
1:\Buildng\Pe n tsELC-PermiZApp.4oc 70/01 /n9 I , _ 1 y .4 ✓ ( S /CO N'WP.
Z00 /Z00'd 880V# et 9313 S31iIf1DS C—. 1E85E5ZE09 99:01 6002/E0/Zl
12-04 -2009 08:39AM FROM-
TI 1 ��. on Cod C � �. 55 , • �J •,'.21ajYQ
f; 71
Name of supervising electrician: ,, << � re._5 Date of request: 1 I GU Dg
Supervising electrician's license number: (� e:4_6 Date ins 1 a :tun was completed: // 0109
o
Electrical permit no,: If a temporary permit is passed az the job si ;ph a with this rm. ase include a copy of • f
6 ti 'i Y)Tla•` - a7 ,. C i; er
Customer' s name: � 1 5� &A- �' .
Customer's 4f
address: /0 6 5G[7 ICJ i 5.�,
City : a-4
' � -
Address of >n s
City:;
Authority having jurisdiction to
Address: 1a. 6
City: �l
Stns
lation jf different than customer's address: e(,.512 c ti) • 4.2
ZIP: 97.'1.43
.kI1, 4
Phone: 0-
Site: ZIP: 93
Phone:
Name of electrical contractor:
Business address: -- Pe k 1445/
City. ?d(o Sti , 3: D ZTP:
Phone:ff ;1 i i, 9 Fax: : O- !- E -mail: ; r e 1 .09u:Ve_?ejeAr; e. , c.am
B.
Restoring electrical service that was interrupted or,disconn
❑ Service change or Uncontrollable event, such
or
Electrical service at a remote location needs to be:
❑ Initialized 0 Restored
Supervising electrician
Note: After sending this form to the electric utility
named above, you MUM send a copy of this form to:
(1.) the electrical contractor, (2) the customer, and
(3) the inspecting authority.
Supervising electrician's signature
N
440 - 0548 -COM (1WO8/COM
400/400 d 58017#
Kequest to _mciergue an L' Iet:tra ai LHS till /nUI1
L200gw
591i13(9 rL 0 06 L !' �'d
d � �.
because of etier a:
cod, or soy( r: weather;
Electrical contractor
Note: By close of business on the fast business day following
energizing of a cornpletu:d installation in response to the above
request, you must: (1) ratify the authority having jurisdiction
that the installation ha_ been energized, and (2) request that the
authority inspect the cnrspleted installation.
Date Electric utility
• Note: Please consider r_otifying the inspecting authority
',_ "1` o identified in this reque t when an installation is energized
q before inspection_
OIa13313 S3 iIl1S
MalteiStittaErAVOOmittgle
T -588 P.001 /001 F -977
\ „ y
License no.: 021e-1/4' /6.
LCHE5ZE09 40:04 6002/EO/Z1.
Plumbilw Permit Application RECEIVED
is y t " = u ` , nt 'r �L l� r
Building Fixtures DEC 3 1 200' u :._`�I'� FI
CE iJSE o
' n'LY �s � ,
°
r e m o City of Tigard Receives / (,
� , � a tc /B I) Permit No _ e0 '(
13125 SW Hall Blvd., Tigard OR 97223 CITY OF TIGAR .
. _ • Y
', I an Review
503.639.4171 Fax: 503,59s.19C CITY
DIVIS Li.. e/ BY: Other Permit No„ • Ay r� .' 4 q
Inspection Line; 503.639-4175
Y T I GARD � e a Date Ready /By: I 0 Se mPnge 21 f
a?wa. t�atl Internet: www.ttgard- or.gov ry Notified /Method: `( Suppleeenra or
o rmati on
TYPE OF WORK FEE* SCHEDULE
N ew construction special 111 New For s � p nl injurntoriort use checklist
Description 7 Qty, ( Ea, 1 Total
bkddition/aiteration /replacement ❑ Other: New I- 2- family dwellings (includes 100 ft. for each utility connection)
/ CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
• -❑ 1- and 2- family dwelling ID Commercial /industrial SFR (2) bath 43778
❑ Accessory building ,lulti- fancily -" SFR (3) bath 500.32
❑ Ytaster builder ❑ Other: Each additional bath/kitchen 25,02
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
,lob site address: / 0 ( b 1?) V- Catch basin or area drain 18.76 4 I
Dryweil, leach line, or trench drain r 18.76
City /State /ZIP: 1 J OA � 10
Footing drain (no. linear ft.: _) Page 2
Suite /bldg. /apt. no.: Project name: °
L1.�5,1z 5 Manufactured home utilities f 50.03
Cross street/directions to job site: Manholes • 18.76
Rain drain connector 18.76
W Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear R.: _) Page 2
Water service (no. linear ft.: ) Page 2
Subdivision: Lot no.: Fixture or Item:
Tax map/parcel no.: 8ackfiow preventcr 31.27
• DESCRIPTION OF WORK Backwater valve 12.51
� C � � / Clothes washer 25.02
�� r " �+" d 411-4-- ak ��''/� Dishwasher 25,02
Drinking fountain 25.02
Ejectors /sump 25.02
❑ PROPERTY OWNER n TENANT Expansion tank 12.51
Name: Fixture/sewer cap 25.02
Floor drain /floor sink /huh 25.02
Address: -
Garbage disposal 25.02
City /Statc/ZIP: V Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
❑ APPLICANT ❑ CONTACT' PERSON Interceptor /grease trap 25.02
_____ Business name: - Medical gas (value: $ ) Page 2
Contact name:
Primer 12.5 1 1
Roof drain (commercial) 12,51
Address:
„ Sink/basin/lavatory 25.02
City /State /ZIP: Solar units (potable water) , 62,54
Phone: ( ) Fax:: ( ) Tub /shower /shower pan f 12.51
G•mail: _ Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name: C. i plV tli n „ �, / Water piping/DWV 56.29
t W
Address; 30 Ai . d� 1X �rQ �[[ 3 25.0 Other; 2
Chy /State /`ZIP: To.,, `�-�G�.n d 9- . j s7 Subtotal
S ) Fax: t� Minimum permit fee: $72.50 51
�� , C I -76.9 f JQ3) a $3pl ""�
Plan review (25% of permit fee)
�✓
Phone: (
CCB Lic.: ,2.L ' 9 ! Plumbing Lic. no.: 34_ /a -r State surcharge (12 %nf permit fee) Cr , 70
Authorized signature: _ , 4 A o TOTAL PERMIT FEE V. ',)-0
Print namear n ,� ,, Date: This permit expires ;fa permit is not obtained within 180 days
77 . Lf V after it has been accepted as complete.
-p I _ _ ;' /'� m_ � f / �( . _ "Fee methodology set by Tri- County Building Industry Service Board.
1:\)eiildil Per ( mils \PUNIU- PennitApp.dee i /0 9 / I ( 4 40 0,/J . /01 /CObI/W£B)
CO/TO Add alVDS D bt56E8ZE05 OE:ST 6002 /tE /Zt