Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2006 -00263
DEVELOPMENT SERVICES DATE ISSUED: 5/12/2006
13125 SW Hall Blvd., Tigard, OR 97223 503-639-4171 PARCEL: 1S134DA - 02500
SITE ADDRESS: 10750 SW NORTH DAKOTA ST ZONING: R -3.5
SUBDIVISION: LOT : JURISDICTION: TIG
Project Description: Run feeder from temp power to existing panel.
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: 1 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: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
JIM ANDERSON CONDUIT ELECTRIC
10750 SW NORTH DAKOTA DBA DUIT LEVEL TOOL CO
TIGARD, OR 97223 19461 SW 89TH AVE
TUALATIN, OR 97062
Phone: 503 - 620 - 8870 Contact #: PRI 503 - 692 - 1428
FAX 503 -692 -3652
FEES
Description Date Amount Reg #: ELE 26 -905C
[ELPRMT] ELC Permit 5/12/2006 $80.30 LIC 109669
[TAX] 8% State Surcharge 5/12/2006 $6.42 SUP 4501S
Total $86.72 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: c 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.
Electrical Permit Application rolz orrlci- usl ()Nl.N.
City of Tigard Received -a( PermitNo.:�� - '
lig
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
C Phone: 503.639.4171 Fax: 503.598.1960 Date/B . Other Permit:
T I G n It D Inspection Line: 503.639.4175 Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard or.gov Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction I7.; Addition/alteration /replacement Please check all that apply:
❑ Demolition ❑Other: ❑Service over 225 amps, comm'I ['Hazardous location
OService over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential
ICJ and 2 family dwelling ❑ Commercial/industrial ❑ Accessory building OSystem over 600 volts nominal units in one structure
❑ Multi - family ❑Master builder ❑ Other: ❑Building over three stories . ❑ Feeders, 400 amps or more
❑Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION 0 Egress/lighting plan RV park
Job no.:C/ Job site address: 10 o 5,(,J, Q.,�,} PAtGO sr.
❑Health -care facility ❑Other:
Submit 2 sets of plans with any of the above.
City/State/ZIP: 1'1G44a) OR C11 a.2.3 The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: Project name: ./b FEE* SCHEDULE
Description I Qty. I Fee. I Total
Cross street/directions to job site: G p pc- (...b, '--p A .,-3 - mp,„J New residential single- or multi- family dwelling unit.
Includes attached garage.
-- RebT'' 1'O 9.AGA-VX <Nolte ►•1O€ \ P4desnP L Mk t- E _ 1,000 sq. ft. or less 145.15 4
Subdivision: 00 Lot no.:),5C0 Ea. add'I 500 sq. ft. or portion 33.40 I
Tax map /parcel no.: '�`a�S�7 Limited energy, residential 75.00 2
PRRCk2 t 5\ 34 Aft - oa Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
dwelling, service and/or feeder 90.90 2
R.1-10 Ft'"EW' - LINE Fil.-6'" `M( NI , Pci.,jee ` �CISCIN1G Services o ceders 'nstallation, alteration, and /or relocation
p( ..I EL i 0 ST4 200 amps or el ss I 80.30 R• l2 2
PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: -3-MN Aiv'MV S 41J 601 amps to 1,000 amps 240.60 2
Address: 10150 S L NOM- Pf\-0310. Sr Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/State/ZIP: 11 G.F\R b e , 47 a-33 Temporary services or feeders installation, alteration, and /or
c 1 relocation
Phone: (Go3) ( % 810 Fax: ( 533) $$ 5 - ci 3(piS 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
❑ APPLICANT I ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: CetaRce. tvyt(„L Caaket..kOne C LLC, branch circuit
Contact name: X0'5 CI \ B. without for service circuits
wilhou! service or feeder fee; 46.85 2
Address: I 9!-{ C., S S, t,J , '39 P P . first branch circuit
Each add'I branch circuit 6.65 2
City /State/ZIP: -\ >j'I II t- . c 7oc,a- Miscellaneous (service or feeder not included)
Phone: ( o3) ' g S 93'7() Fax:: ( 503) g$�j - q 3 63
Pump or irrigation circle 53.40 2
Sign or outline lighting 53.40 2
E - mail: rob (6 Ct .ctor rvt t\ CC . COW\ Cam 5 523 •31 6c,39 Signal circuit(s) or limited-
CONTRACTOR energy panel, alteration, or
extension. Describe: Page 2 2
Business name: CM - 1...e(, C
Address: to„...,‘ t S, , $q`11- Actg, Each additional inspection over allowable in any of the above
Per inspection 62.50
City / State/ZIP: 1- .` 1 c)1b 4 - Investigation per hour (1 hr min) 62.50
Phone: (56 CCI"X jL }g 1 Fax: ( ) (,q 36 51 Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
CCB Lic.: 109 “, 9 Electrical Lic.:;;/ (0-9p5C Suprv. Lic.:L/50 / 5 • Subtotal:
Suprv. Electrician signature, required: Plan review (25% of permit fee):
State surcharge (8% of permit fee): r ( I qL�
Print name: Date: 05/ r j I G f
TOTAL PERMIT FEE Q` „ 7.2_
Authorized signature: R ` This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: (LL C .. t.O . vim Date: 0 5/ I 0 ( • Fee methodology set by Tri- County Building Industry Service Board
•• Number of inspections per permit allowed.
1:\ Building \Pennits\ELC- PermitApp.doc 03/23/06 440- 4615T(I I /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*
El Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
El 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
El Boiler Controls
El Clock Systems
El Data Telecommunication Installation
E l Fire Alarm Installation
El HVAC
El Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
El Medical
El Nurse Calls
El Outdoor Landscape Lighting*
•
E l Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1:\ Building \Pamits\ELC- PamitApp.doc 03/23/06
CITY OF TIGARD
BUILDING DIVISION PERMIT #: i :L_c2006. 1263
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: ° 1212,OO a
Phone: (503) 639 -4171 Avil
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 5f•iE12t)O6 TIME: 7:02AM PAGE: 133
SITE ADDRESS: 10760 ;'7W NOR`111 DAKOTA a= [ CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: ANDLRSON
DESCRIPTION: Pins feeder temp rower to existing 1; nee.
OWNER: ANDERSON, JIM PHONE #: -(13 1320.88870
CONTRACTOR: COMM ELECTRIC PHONE #: 60: 69'2: '1420
Inspection Request Scheduled For: Date: ;; /16/200G Pour Time:
Code # Inspection Description Confirm # Contact # Message
120 t:.:l as-:tric tl re.iuc;i, ire 0299'10-01 .: 't03- 332.6639
°`c1 F%n1 a\_.
Corrections /Comments / Instructions:
„` r(),t4 r .. . ` 1 - 1 o K) P A . CzN D u► - D is
ANbvUcr,.,K,s R,vIN
.�..
4
R v) FI APP ,
e elect al instl lation defectc notcd
on this repo - Abe be corrected and
calend: . ays per • R 918- 271 -0030
1 %
'CY 0010. W OKI( ,
3 ' 1 • otV G- • (K
4110 PASS PARTIAL APPROVAL n CANCEL ❑ NO ACCESS
n FAIL n CALL FOR INSPECTION ADDITIONAL FEES ASSESSED
Inspector: 6� t Date: It b Phone #: (503) 718- 14I14 -