Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2008 -00534
COMMUNITY DEVELOPMENT DATE ISSUED: 9/12/2008
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2 S 102AD -01900
SITE ADDRESS: 08935 SW BURNHAM ST ZONING: CBD
SUBDIVISION: LOT : JURISDICTION: TIG
PROJECT: TVF &R
Project Description: (1) branch circuit to office and meeting 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: SIGNAUPANEL:
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 FIRE + RESCUE RITE WAY ELECTRIC
20665 BLANTON ST 2904 THREE LAKES RD. SE
ALOHA, OR 97007 ALBANY, OR 97321
Phone: Contact #: PRI 541 - 926 -0504
FAX 541 - 926 -2656
FEES
Description Date Amount Reg #: ELE 22 -77C
[ELPRMT] ELC Permit 9/12/2008 $46.85 L1C 40077
[TAX] 12% State Surchar 9/12/2008 $5.62 SUP 32495
Total $52.47 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: �i i - ittee Signature: 5
/77/7 (14X> /
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.
Sep.12. 2008 3 :05PM \lo.9065 P. 2/2
`• 1 Electrical Permit Application vi.); t)1 -1. ;C i ',I: O.\ IN
i'!• C. tit' of Tigard 1�J .1� 1Z 4 i _ rr __
II 1 M,Di AMR
, 13125 SW Hall Blvd., Tigard, OR 97223 p i e
Phone: 503,639.4171 Fax; Fax; 503 -59: L.i 17)=03 _ __ 17)=03 . ► - e �,; ii
I ; fc :n x I) Inspection Line: 503.639A175 I 00 Dare Ready/By: , is ' El See puce 2 for
Internet_ wwtv.tigard-or.gov • , 44 • lb Notified/Method: ,/ Stipplementnl batarmution
om »
%I Pl check all that apply (submit sets of plans w /items checked below ;
❑ New construction [�Additlon/alteration/•,•. .: � .� � aPP Y ( � P )
III Service or feeder 400 amps or more ['Building over three stories.
❑ Demolition 0 Other: �, where the available fault current 0 Marinas and boatyards.
.` .,
exceeds 10,000 amps at 150 volts or El Floating buildings.
�cA�cx��r ..v�� t Orh
less to ground, or exceeds 14,000 El Commercial -use agricultural
❑ 1- and 2- family dwelling El Commercial/industrial ❑ Accessory building seisp fur all other installations. buildings.
❑ Multi- family 0 Master builder ❑ Other 0flivi pump. 0 Installation of 75 KVA or
.IOB ' $11 1Q�t1F' tMA1IOI+I..friN! :1 () `1'I(3OcrT. , . otor load of separately "1 derived system.
•znerseoon' ,� u8R
- _ ,.. Addition of ttew m ❑ A °. ">= ",
Job no.: 2 Job site add ress: 7 1003 or more. l ecre ancy.
I. iyVY YI 1 0 Six or mare mider sf mats. El Rce*wtional vehicle parks.
City/Stare/ZIP : T ❑ &with- facilities. 0 Supply voltage for more than
J (� �' 'C [] Hazardous locations. 600 volts nominal
Suite/bldg./apt no.: Project name: 0 Service or feeder 600 amps or more.
Cross street/directions to job site: ■.,':>' :'� P,07)L -
� Ia ! �' , I l � ! •ruin !
------- New residential single- or multi - family dwelling Wait.
Itrclades attached garage. __
Subdivision: Lot n o. : 1,000 $q- ft. or less 145.15 4
Tax map /parcel no.: �`�`""" Y —, Ea_ add`l 500 sq. 8_ or portion 33.40 1 Limited energy, • residential 75 00
'SCRH'F1)N OF :`VV4X{ :,. MI abavc s4. ft-)
( 2
:DE
` Limited energy, multi - family 75.00 2
Q ‘ Cr:� b �' c _ \ c rc jet, A,�, i C q is;e_, , - _ residential kith above sq. R)
yytr r-8..r..c� Services or feeders installation, alteration, and/or relocatian
R. »6 200 amps or Icss __ 80.30 2
D Pf(WERP OWNS * [ U Ni% T 201 amps to 400 amps 106.85 2
V . ` 401 amps to 600 amps 160.60 2
Name. V w • t {� - `t"� 9\.'e: lJ�. 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
tit' (State/ 1P: Temporary services or feeders installation, alteration, and /o
relocation
Phone: ( 503) c; , 2_, .r 2,CD Fax: ( ) 200 amps or less 66.85 1
Owner installAtlon: 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' Datc° A. Fee for branch circuits with
' ` , above service or feeder fee,
6 2
cacti branch circuit
Business name: B. Foe for branch circuits
without service or feeder fee, 46.85
Contact name: first branch circuit i y 2
Address: Each add'! 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 in circle 53.40 i 2
. , .., COIq __ _ _
C`I 4R . . Sign or .40 2
,';' outline lighting 53
Business name: , g -- , I Signal circuit(s) or limited -
Business 'l * e W i \,'' I.�+ i'�'if,_r ■ e,, 4 �o.._. energy panel, alteration, or
Address: r CA. C) -i -`(� \ —OX .S , S sion. Descnbf- Page 2 2
City /State/ZIP: R \,t o `t , t` Each additional inspection over allowable In any of the above
Per inspection 62.50
Phone: ( 1 ) r i z ( i _ 0 5 0 4 Fax: ( 54 i ) q 2 6 - ' 2 - 6 a L Investigation per hour (1 hr min) 62.50
CCB Lie_: L4Q�_ Llectrical Lie.: .�. Suprv. Lie.: ��.(Ck S Industrial plant per hour _ ` 73.75 _ —
Suprv. Electrician signature, required: Subtotal: I-f b ; 06
Print name: E Ary\ -' � ' �S t,s S Yy\ , Date: >` 0 Q' Plan review (25 ° h of permit fix):
1 / Ll State surcharge (12 %ofpermit fee): ^ 5 b 2.
Authorized signature: p, 4 1�� — TOTAL PERMIT FEE: 5 a, ,i- f 1 7
This permit application expires if a permit is not obtained within ISO
Print RmmC: `tti 1 y � \ : O — ham days after it has be aeeeptni as eenrplete.
7 1 C7ate • Number of inspections allowed per permit.
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CITY OF TIGARD
BUILDING DIVISION • PERMIT #: ELC2008- 00534
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/12 /2000
Phone: (503) 639 -4171 r
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 9/17/2008 TIME: 7:OOAM PAGE: 34
SITE ADDRESS: 08935 SW I3URNHAM ST CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: TVF&R
DESCRIPTION: (1) branch circuit to office and meeting room.
OWNER: TUALATIN VALLEY FIRE a RESCUE, PHONE #:
CONTRACTOR: RITE WAY ELECTRIC �� . PHONE #: 541 926 - 0504
• Inspection Request Scheduled For: Date: 9117/2008 Pour Time:
Code # Inspection Description /'- Connfirm # Contact # Message
199 Electrical final 075483.01 541- 926 -0504 Y
Corrections /Comments/ Instructions:
• LARR1 -. wv+t . T1 y• 5 41 •140 • r1'��"5
❑ PASS n PARTIAL APPROVAL ►2 CANCEL ❑ NO ACCESS
❑ FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Cam—+ N68 1-E" Date: c i ( I 111) Phone #: (503) 718- 1-1414{j