Permit CITY TELECTRICAL PERMIT
T TIGARD [ PERMIT #: ELC2006 -00406
y ��i, DEVELOPMENT SERVICES DATE ISSUED: 7/26/2006
•= 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S101 DC - 00900
SITE ADDRESS: 13935 SW 72ND AVE ZONING: I -H
SUBDIVISION: LOT : JURISDICTION: TIG
Project Description: Reconnect only for unit #1 (right - hand side).
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: id
CHARLES & HICKETHIER
9220 NW LOVEJOY
PORTLAND, OR 97229
Phone: 503 - 704 - 0860 Contact #:
FEES
Description Date Amount Reg #:
[ELPRMT] ELC Permit 7/26/2006 $66.85
[TAX] 8% State Surcharge 7/26/2006 $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 . 80 -days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set
forth • OAR 952 - 001 -0010 t. • h • • - 952 - 001 -0100. You may obtain copies of these rules or direct question, to OUNC at 503 -2 6 -6699 or
1 -8 0- 332 -2344. •
Is ed By: AO Permittee Signature: J "�e (del
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.
El ctr cal Permit Application <, . w; . . e � - �,.,` r 1'' o t 1 'ICI: t�ti l � �
P aK = City of Tigard Date/By. 7 D 4, j? Permit No.. e'�d i'j6Gj' D�
i q 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
: ®' ' Phone: 503.639.4171 Fax: 503.598.1960 Date /By Other Permit:
f G Inspection Line: 503.639.4175 Date jut : El See Page 2 for
Tyll G A R.I� P Read /B Y Y 1
.7ia1 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 exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 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 -2 ", "I -3 ",
R �({, c a 0 100HP or more. occupancy.
Job no.: Job site address: 3 �3 �$C.� 7.2_ � t ❑ Six or more residential units. ❑ Recreational vehide parks.
City/State/ZIP: ---44, d 7��3 ❑ Health -care ca ties. ❑ Supply voltage for more than
`ry ❑Hazardous locatioons. 600 volts nominal.
Suite/bldg. /apt. no.: VVV Project name: ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description 1 QtY. I Fee. 1 Taal 1 •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Tax map/parcel n o.: Ea. add'I 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
DESCRIPTION OF WORK • � (with above sq. ft.)
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 1 ❑_ TENANT L ! j 201 amps to 400 amps 106.85 2
t A. � a( L id /i ta'C- '/C 401 amps to 600 amps 160.60 2
Name: Ghei 4 ( 4 _1.1, A 1- t/ .ed <C, -i-ktl� 601 amps to I,000amps 240.60 2
!
Address: f2 0_0 A le) jaue_ 4-0t7 Over 1,000 amps or volts 454.65 2
City /State/ZIP: n� f ,,( J �� c � '',� Temporary services or feeders installation, alteration, and/or
{ 1J /7 / s ,� relocation
�'�° / 200 amps or Tess 66.85 1
Phone:(503) /0y 09 (,0 I X 03) agz bg_25- — i
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, per 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'I branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City /State/ZIP: Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Phone: ( ) Fax: : ( ) Reconnect only / 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: (06 • 5
Print name: Date: Pla revi (25% of permit fee): _
' State surc (8% of permit fee): n 9 . 7j 5' Authorized signaturei� 2 — TOTAL PERMIT FEE: - 7A •.
This permit application expires if a permit is not obtained within 180
Print name: r, i4! (/e J •� 1 L' pA4 i . r Date: ,2 d 4 days after it has been accepted as complete.
• Number of inspections allowed per permit.
I:\ Building \Penniu\ELC- PermitApp.doc 05/23/06 440- 4615T(1I /05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
- RESIDENTIAL.WORK;ONLY: t
Fee for all residential systems combined .. $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
El Burglar Alarm
El Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
;- .COMMERCIAL WORKCONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
El Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
El Fire Alarm Installation
El HVAC
❑ Instrumentation
El Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
El Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1:\ Building \Permits\ELC- PermitApp.doc 03/23/06
CITY. OF TIGARD _
BUILDING DIVISION PERMIT #: EI_,C2006- 00400
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/25/2006
Phone: (503) 639 -4171 '1I
Inspection Requests (24 Hrs.): (503) 639 -4175 a s� " _..
INSPECTION WORKSHEET FOR DATE: 2/2/2007 TIME: 7 :03AM PAGE: 60
SITE ADDRESS: 13935 SW 72ND AVE CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: HIC.KEFHIER
DESCRIPTION: Reconnect only for unit #1 (right - hand side).
OWNER: HIS.KELHIER, CHARLES & LLOYD PHONE #: 503 - 704 - 0850
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: 2/2/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
115 Electrical service 042900 503.502 - 0848 Y
Corrections /Comments /Instructions: 0V(1 ��
i5v ��
• t � .1 V�
N U ' a.a'�Ap tJ 6 L ict 1 47 F; VT 0(4 I/\) I4 V 6
?Rtv■04 cLE KaN .0
vz v 3 36 1,1 ; sr`rV € -
G`� t4.L u4 176
\Ai (. - L - 'To c1� � ��
1
CC
c
1 1 11 !°1
n PASS n PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: �h 66 Date: 2 6 - 1 P hone #: (503) 718- 0(4
,