Permit C I T 1 OF T I R D ELECTRICAL PERMIT
PERMIT #: ELC2005 -00125
I l_. DEVELOPMENT SERVICES DATE ISSUED: 3/2/2005
:.�.. 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171
PARCEL: 2 S 102AC -01704
SITE ADDRESS: 12720 SW PACIFIC HWY
ZONING: CBD
SUBDIVISION:
BLOCK: LOT : JURISDICTION: TIG
Project Description: Branch circuit for AC.
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:
SPRINGER, JERRY C HUNGNAM OH ELECTRIC
7400 SW FAIRWAY DR 15865 STRATFORD LP #B
WILSONVILLE, OR 97070 PORTLAND, OR 97224
Phone: Phone: 503 - 381 - 4910
FEES Reg #: ELE 34 -461C
SUP 4375S
Description Date Amount LIC 126274
[ELPRMT] ELC Permit 3/2/2005 $46.85
[TAX] 8% State Surcharge 3/2/2005 $3.75 REQUIRED ITEMS AND REPORTS
Total $50.60
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 -0699 or 1-800- • 2 -23
Issued By: 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 639 -4175 by 7:OOpm for an inspection the next 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 „ .
Electrical Permit A PP ication FOR OFFICE USE ONLY
City of Tigard MAR 0 2 2005 Received„ I + Pe mitNo.:G _—(vi tY g DateB : 3- J
13125 SW Hall Blvd., Tigard, OR 97223 Plan Revi w
Phone: 503.639.4171 Fax: 503 $ 1 1, 60 Other Permit:
�� OF � t � DateB
1 WA Inspection Line: 503.639.4175 e � Date Ready/By: J3 ( H See Page 2 for
In www.ci.tigard.or.usBUILDING DIVISION Notified/Method: / \ Supplemental Information
g li_�t t ,t iF�*'Y x i' _z' a f 'TYPE tIF' % ORF: � :... �$ _. rt ; ,..,4 ,.c :�i � H ' PLE�.1�I B WIEW'
-.- ..1 s �., t... „.k .. �..:: :''z. ,� ... ��„ _. .,.. .. - ..: ,, . �..,_ r., .''� .t r ... �'�, s> �. .. �x�r'�f -yr �:..'. s �, ,�:V ...a`, ^s.�., ,_ .. .,. -
❑ New construction Addition /alteration/replacement Please check all that apply:
❑ Demolition El Other:
Service over 225 amps, comm'l ['Hazardous location
❑Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
i 1 ,. i - y� sc a Y�-, .,t �,''"3 t wr dr, 1 �#
- 1 CATE`GO �' OF CONST`RUdit5N . k _ of 1- and 2- family dwellings 4 or more new residential
❑ 1- and 2- family dwelling Commercial/industrial ❑ Accessory building ['System over 600 volts nominal units in one structure
['Building over three stories ❑Feeders, 400 amps or more
❑ Multi - family 0 Master builder
❑ Other: ['Occupant load over 99 persons ❑Manufactured structures or
'rzk v ; t S ; , JOB SITJ �INFdR�V IATZON Lo ATJON;, z ,i g`.�_ ;-- : ` p' a`•. ❑ plan RV park
Job no.: _ Job site address: h L,_ 1 ❑Health -care facility ❑Other:
' 1 2 U t ra �' - I i ”' Submit 2 sets of plans with any of the above.
City/State /ZIP: 'i CA-4 - A 1 D The above are not applicable to temporary construction service.
g F
Suite/bldg. /apt. no.: -- Project name: -' °"" E ECHEIJTTLE • . .
Description Qty. I Fee. Total
Cross street/directions to job site: l Ct C. f'-■C- \/ New residential single - or multi - family dwelling unit.
I Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
Tax map /parcel no.:
Limited energy, non - residential 75.00 2
g _ ; - r s �r '` , t rDESCR 1ON Ok ORK , , .2T ; , ' „' : ' , .
. 1 4 „,, u... h t...� ,,;,vt _ .: -.... -.. ...,... ..r <,_s , ,. _ ,.,. _R , Each manufactured or modular
R�GO n h ¢-_ b j dwelling, service and /or feeder 90.90 2
c. �Y , 6 (' / (i (t h . � Services or feeders installation, alteration, and /or relocation
((( 200 amps or less 80.30 2
x 201 amps to 400 amps ❑ PROPERTI' O � . s ` x� P mP s 106.85 2
;} ,..._.. .... ., ' } q❑ TP ; ' .�., 401 amps to 600 amps 160.60 2
Name: 601 amps to 1,000 amps 240.60 2
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 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
€. et z ' ,1„ 2, ii ,, APP)tI=c NT_ ' 1 "' ; t ' - ` ® :CONTACT PE OLY z" ' s 0. A Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: (A n h a- fry) 9 k ( branch circuit
z Y ��� C. B. Fee for branch circuits
Contact name: U z Y--- r) without service or feeder fee, 1 46.85 4 b A----' 1
Address: S ` ( ` IA L� each branch circuit
lid Each add'1 branch circuit 6.65 2
City /State /ZIP: I , -6?-4---d,_ 1 d ,e____ 1 7 7. Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: (�0 3 )3 S I - 441 I 0 Fax: : (, - a 3) 9f? s - / /7 2_ �j Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited-
s q " r „1 M� . -; energy panel, alteration, or
':t . . ' ¢ t . k L'ONTRACTOTi . -” � ..,. - -' ur. _ --
extension. Describe: Page 2 2
Business name: .,�-- ( u n h a 141 D f n (, fi c-
rJ Address: ( ' ,F) � / 9trt - (- L r # Each additional inspection over allowable in any of the above
r& vv Per inspection 62.50
City /State /ZIP: ' `la--- A_ Q f q J7 ' 'j.- Investigation per hour (l hr min) 62.50
Phone: (5 33 R1 y 11 v Fax: ( , � D �( t0� Industrial plant per hour 73.75
' ,ads; .'.,'&" , E PER_ MITF •.
I _ CCB Lic 12 d 2 ` f' 1 1 Electrical Lic 4 -4 CI Suprv. Lic.4 3 /) •- s Subtotal 1.46 r-)
Suprv. Electrician signature, required: - . i rf- Plan review (25% of permit fee)
Date: > y o ,.c----
State surcharge (8% of permit fee) 1 5
Print name:
¢l� � / /
TOTAL PERMIT FEE 50 b v
Authorized signature: - This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: L„, IM b k Date: 3 Z 0 S" * Fee methodology set by Tri- County Building Industry Service Board
** Number of inspections per permit allowed.
i:\Building\Permits\ELC- PermitApp.doc 12/03 440- 4615T(10 /02/COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
PRESIDE ,} WWWWW:alinE ,`giro
Fee for all residential systems combined........ $75.00
Check Type of Work Involved:
❑ A udio and Stereo Systems*
❑ Burglar Alarm
❑ G arage Door Opener*
❑ 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
❑ 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:\ BuildinePermiu \ELC- PermitApp.doc 04/03
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2005 -00125
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 3/2/2005
Phone: (503) 639 -4171 / �rembh�'� call,
Inspection Requests (24 Hrs.): (503) 639 -4175 .x 1 11.
INSPECTION WORKSHEET FOR DATE: 3/23/2005 TIME: 7:08AM PAGE: 22
SITE ADDRESS: 12720 SW PACIFIC HWY CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: PUBLIC SERVICE LABRATORY
DESCRIPTION: Branch circuit for AC.
OWNER: SPRINGER, JERRY C, PHONE #:
CONTRACTOR: HUNGNAM OH ELECTRIC PHONE #: 503 -381 -4910
Inspection Request Scheduled For: Date: 3/23/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 002685.01 603-381 -4910 N r
Corrections /Commenfs /Instruction I �
�— 2-OO
- - V C, f kv fAis IT)
N
/
PASS ❑ PARTIAL APPROVAL LI CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: GfA _// Date: 7 - .23 tS Phone #: (503) 718 - Y V