Permit ELECTRICAL PERMIT
CITY Y OF TIGARD
PERMIT #: ELC2006 -00244
DEVELOPMENT SERVICES DATE ISSUED: 5/8/2006
---�' 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S 102AA -02800
SITE ADDRESS: 08770 SW SCOFFINS ST ZONING: CBD
SUBDIVISION: TIGARD HIGHWAY TRACTS LOT : 026 JURISDICTION: TIG
Project Description: (1) circuit for kiln in room across hallway from electrical room.
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: 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:
TUALATIN VALLEY MENTAL HEALTH CE ELECTRICAL CONTRACTOR SERVICES N.W.
8770 SW SCOFFINS RD 31378 DOWD RD.
TIGARD, OR 97223 ST. HELENS, OR 97051
Phone: Contact #: PRI 503 - 366 -6060
FEES
Description Date Amount Reg #: ELE 5 -56C
[ELPRMT] ELC Permit 5/8/2006 $46.85 LIC 155460
[TAX] 8% State Surcharge 5/8/2006 $3.75 SUP 3289S
Total $50.60 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 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 -2344.
Issued By: -L Lz / �� 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'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.
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Electrical Permit A�lication. � � `:" . "L` A, : �, F ti ir. ,( .
City of Tigard U namna . - WM t i
13125 SW Hall Blvd., Tigard, OR 97223 C Plan Review Other Permit:
Phone: 503.639.4171 Fax: 503.598.1960 i .••t 4 ` � 7 Q� u '.' , ' Date/El : fa rice page 2 for
� • 1 �! 1 ' i ° , J Date Reedy/By:
inspection Line: 503.639.4! 75 «, Notified/Method: Sappiementel Iniormatien
Inner: www.ci.tigard.or.us 1 :;t- Y I CI PSO
TYP ! • ' tit CVISI PLAN REVIEW
1 ,
Please check all that apply
❑ New construction i Addis dil/alteraIion/rsplac:etnent
['Service over 225 amps, comm'I ❑Hazardous location
o Demolition 0 Other. ❑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
❑System over 600 volts nominal units in one structure
CI i - and 2-family dwellingC otnmorc i allindustrial [] Accessory building
['Building over throe stones ❑Fceders, 400 amps or more
❑ Multi - family ❑ Master builder _ ❑ Other: ['Occupant load over 99 persons DManufitctured structures or
JOB SITE INFORMATION AND LOCATION OEd/wesllighting plan RV park
QHealthcary &edity ❑Other:
Job no.: ti % y Job site address: a S a 1 n Submit sets of plans with any attic above.
n 2 � me above arc not applicable to temporary construction Lion service,
City/State./ZIP: '7% �a� CSR. 1 3
� ` , r FEE* SCHEDULE
Suite/bldg. /apt � no.: I Project name: ‘ A ft Rk g 1 V W neat tptne —1 Q j Fie. J Too l -.
Cross street/directions to job site: New residential sing!" or multi- family dwelling unit.
Includes attacked garage.
C - .-2 `L • / 1 WVE ,i • 5U3 — 1 s 1,000 sq. ft or less [ 145.15 4
Lot no. • Ea. add'l 500 sq. lt. or portion 33.40 1
Subdivision: _ gy. �ti� w 75.00 _ 2
Tax map/parcel no.: Limited energy, non-residential - 75.00 2
DESCRIPTION OF WORK Each manufactured Or modular
dwclli : service and/or feeder 90.90 2
O 3 0 S4 A C 11 c to - a lk g 1► • 1 • 4 _Services or feeders installation, alteration, and/or, relocatbc
200 amps or less 80.30 2
S. : • . i A & Y: • 1 J ti t _ a . ■ b • Id 201 amps to 400 amps 106.85 2
0 piton E:R'TY OWNER El TENANT 401 amps to 600 rumps 160.60 _ 2
Name: 601 amps to 1.000 amps 240.60 2
Over 1,000 maps or volts 454.65 2
Address: Reconnect only 66.85 2
City /State/ZIP: Temporary services or feeders Installation, alteration, and/or
• Phone: ( ) Fax: ( ) 200 Bumps or Tess 66.85 I
Owner Installation: This installation is being made on property that 1 own which is not 201 amps to 400 amps 10030 2
intended for sale, lease, rem, or exchange, according to ORS 447, 449, 670, and 7 01. 401 amps to 600 amps 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, r panel
❑ APPLICANT I ❑ CONTACT PERSON A. Fee for branch circuits with
. service or feeder lee, each 6.65 2
Business name: branch circuit ,
B. Fee for branch circuits
Contact name: without service or feeder foe, 1 46.85 g 2
first branch circuit
Address: Each add branch circuit 6.65 2
City /State/ZIP: Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: ( ) Fax :: ( ) Sign or outline lighting 53.40 2
E-mail: Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or
C `, I extension_ Describe: Page 2 2
Business name :E p� \col. Ca QC�QIp4 Sete toes. N W
Address _ .)`3l1 2 tact "F ion R a Eacb additional inspection over alIowabie In any of the above
i � Per inspection 62.50
City /StatdZlP. •a — - - • ` e , • • Investigation per hour '(i hr min) 62.50
PhOtfe: ( 503 ) 16 6— is 0 I • Fax: ( 503 9 in.- S S 1 R Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
CCB Lic.:% E ' •i:: ic.: 5� Suprv. Lic..3 29 S I Subtotal t S
Suprv. Electrician signature, road' • 40......, - Plan review (25141 of permit the)
p 1 - Date: S _ State surcharge (8% of permit fee) 3`l-
Print name:
1 it`L Q 1 L v �+ R 1 C� ��1 TOTAL PERMIT FEE .. so �a
f(' - DCI tLC e c S ns ul . cal e.. This permit application ezpires lin permk is not obtained within BIO
days after It has been accepted m e ptete V
Print name: Date: • Fee methodology IN by Tri -County Building Industry Service Board
• • Number of impeotione per permit allowed.
i.mul App.deo I71b7 44646137(10 ovcoMMr/waa