Permit * K� T, CITY OF TIGARD ELECTRICAL PERMIT
` PERMIT ISSUE : ELC2007
COMMUNITY DEVELOPMENT
DATE ISSUED: 10/18/2007
TtGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S 102C B -03400
SITE ADDRESS: 09800 SW FREWING ST 42 ZONING: R -12
SUBDIVISION: CHARLOTTENHOF APARTMENTS LOT : 009 JURISDICTION: TIG
PROJECT: CYPRESS CREST APARTMENTS
Project Description: Reconnect only
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: 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: 1 SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
KENDRA CARLSON
9800 SW FREWING #33
TIGARD, OR 97223
Phone: 503 - 684 - 0624 Contact #:
FEES
Description Date Amount Reg #:
[ELPRMTI EEC Permit 10/18/200' $66.85
ITAX] 8% State Surcharge 10/18/200' $5.35
Total $72.20 REQUIRED ITEMS AND REPORTS
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All
work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for
more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in
OAR 952 -0• •. • through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
Issued B l � i , • Permittee Signature: p
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Electrical Permit Application � tiz.i k r r, , FOR OFFICE USE ONLYr , ! kr `
R eceived %.
III —'�i of Ti and o Permit No.:
25 g Date/By. ' l 07 j::::, L�° 7— 7� 6
n 1312$ SW Hall Blvd., Tigard, OR 97223 Plan Review
G Phone: 503.639.4171 Fax: 503.598.1960 DateBy. Other Permit:
"P I ' A R n. Inspection Line: 503.639.4175 Date Ready /By: lur BI See Page 2 for
- _. Internet: www.tigard or.gov Notified/Method: / / Supplemental Information
' TYPE OF WORK PLAN REVIEW
❑ New construction ❑ Addition /alteration /replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION o or
Commercial-use agricultural
exceeds 10 000 amp at 150 volts o Floating buildings.
less to ground, or exceeds 14,00 ❑ Commercia -use agricu tura
❑ 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
❑ Emergency system. larger separately derived system.
• JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A ", "E ", ° I - ", "1 -3 ",
Job no.: Job site address: Q�Q��O ` l T p N ] 100HP or more. occupancy.
❑
1 Jl�� �w \v` t 0 Six or more residential units. Recreational vehicle parks.
City/State /ZIP: ( 4 ( � art ❑ Health -care facilities. ❑ Supply voltage for more than
T V ` 1 �a 3 ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: 4 Project name' ' t_, s =` _ ■ Service or feeder 600 amps or more.
(� 11 ` ' 1\_ l FEE SCHEDULE -
Cross street/directions to job site: i�` IJ� c , -� 1 Description 1 Qty. 1 Fee. [ ToTotal 1
�� New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
,� �� ((`` ;(�
. DESCRIPTION �� ( OFF WORK
/� (�� (with above sq. ft.)
( '� - Q> rf Qs — \ ` D RO , l Limited energy, multi - family 75.00 2
residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
• ' . ❑ PROPERTY OWNER . ❑ 201 amps to 400 amps 106.85 2
Name: V ... 4 .. 00� "p�� 401 amps to 600 amps 160.60 2
" WSJ 601 amps to 1,000 amps 240.60 2
Address: q de + = — - WA I • Over 1,000 amps or volts 454.65 . 2
City/State /ZIP: ,m �-� Temporary services or feeders installation, alteration, and/or
c)Y relocation
Phone: (6:5,3 l4 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 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Branch circuits - new, alteration, or extension, r panel
Owner signature: Date: A. Fee for branch circuits with
. ❑ "APPLICANT _ 1 ❑ CONTACT PERSON . • above service or feeder fee, 6.65 2
each branch circuit
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee, 46.85 2
first branch circuit
Address: Each add] branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City/State /ZIP: Each manufactured or modular
T dwelling, service and/or feeder 90.90 2
Phone: ( ) Fax: : ( ) Reconnect only I 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR . Sign or outline lighting 53.40 2
Business name: Signal circuit(s) or limited -
energy panel, alteration, or
Address: extension. Describe: Page 2 2
City/State /ZIP: Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: ( ) I Fax: ( ) Investigation per hour (1 hr min) 62.50
CCB Lic.: I Electrical Lic.: I Suprv. Lic.: Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES .
Suprv. Electrician signature, required: Subtotal:
Print name: Date: Plan review (25% of permit fee):
State surcharge (8% of permit fee):
Authorized signature: )( • TOTAL PERMIT FEE:
Th 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:\Building\Permits\ELC- PermitApp.doc 05/23/06 440- 46t5T(tt /05 /COM/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 $75.00
system .
(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
Fl 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- PermitApp.doc 03/23/06
CITY OF TIGARD
BUILDING DIVISION PERMIT #: EL 02007. 00718
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1O /1;V/20O7
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 � p:...
INSPECTION WORKSHEET FOR DATE: 10/19/2007 TIME: 7:01AM PAGE: 31
SITE ADDRESS: 09800 SW FREWING ST 47 CLASS OF WORK:
SUBDIVISION: CHARLO tTENI IOF APARTMENTS LOT #: 009 TYPE OF USE:
PROJECT NAME: CYPRESS CREST APARTMENTS
DESCRIPTION: Reconnect only
OWNER: CARLSON, KENDRA PHONE #: 503-G84 -0624
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: 10/19/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
116 Electrical service 05794E -02 503.684 -0624 N
Corrections /Comments /Instructions:
Jj PASS n PARTIAL APPROVAL ❑ CANCEL NO ACCESS
1 I FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: G—• Date: Jc1 I11O1 Phone #: (503) 718 - 2,