Permit CITY OF TIGARD ELECTRICAL PERMIT
° PERMIT #: ELC2006 -00546
° COMMUNITY DEVELOPMENT DATE ISSUED: 9/28/2006
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 25101 AA -09700
SITE ADDRESS: 12587 SW 68TH AVE ZONING: MUE
SUBDIVISION: PP1996 -024 LOT : 001 JURISDICTION: TIG
Project Description: 10 branch circuits. 11/28/06 changed address (from 12585 68th Ave)
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/ SVCI 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: 9 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:
MARK NIELSON CLACKAMAS ELECTRIC INC.
7150 SW HAMPTON PO BOX 51
STE. #228 BEAVERCREEK, OR 97004
TIGARD, OR 97223
Phone: 503 582 - 5777 Contact #: PRI 503 - 632 -2420
FAX 503 - 632 -2421
FEES
Description Date Amount Reg #: ELE 3 -606C
[ELPRMT] ELC Permit 9/28/2006 $106.70 LIC 161932
[TAX] 8% State Surcharge 9/28/2006 $8.54 SUP 5041S
Total $115.24 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: 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.
:4 -----
• SEP -21' t.P1006 02:34P FROM:CLACKAMAS ELECTRIC 5036322421 TO:5035981960 P.2
Electrical Permit Application 1 () 14 (H i t 1 i l t t N I
City of Tigard NReceived 9'� � ' Pwmi Ne.: .4
tY g d D : ♦ i j J _ . i
13125 SW Hall Blvd., Tigard, OR 972 2 7 2006 plan Ravi- -
Phone: 503.639.4171 Fax: 503.598. " ' A , ; i Daten3 Other Permit:
Inspection Line: 503.639.4175 !. 4- ' _ Date Ready/By See Page 2 for
Internet www.ci.tigard.or.us \ l ,
. L. . „L„.., _.. ,s
.' :,- - Notified/ Method. Supplementallnfornation
. 7 i s Tili 3 C450 -A WORie " 71 x '' PLAN REVIEW
❑ New construction ® Addition/alteration/replacement Please check all that apply:
❑ Demolition ❑ Other. ❑Service over 225 amps, oomm'I ❑Hazardous location
['Service over 320 amps — rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION 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
El Multi - family ❑ Master builder ❑ Other: ❑Building over three stories ❑Feeders, 400 amps or more
❑Oooupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress/lighting RV park
Job no.: I Job site address: - 13586 -SW 68 Ave. ❑H -care facility ❑
Submit 1. sets of plans with any of the above.
I
City/State/ZIP: Tigard. OR. 97223 f e 2 587 The above are not applicable to temporary construction service.
Suite/bldg./apt.no.: I Project name: U50-Nr\. FEE' SCHEDULE
pperlWlpo 1 Qty. 1 Fee I Total 1 '•
Cross street/directions to job site: New residential single- or multi-family dwelling unit.
Includes attacked garage.
1,000 sq. ft. or less 145.15 4
Subdivision: I Lot no.: Eo. add'1 S00 sq. ft. or portion 33.40 1
Tax map/parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
DESCRIPTION OP WORK Each manufactured or modular
Replace or alter 10 circuits dwelling. service and/or feeder 90.90 _ 2
Services or feeders lnstalladon, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: Nielson Insurance 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
Phone: ( ) 1 Fax: ( ) relocation
200 amps or less 66.85 1
Owner installation: This installation is being made on property that 1 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 t CONPACf PERSON A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: Clackamas Electric Inc. branch circuit
Contact name: Scott Johnston B. Fee for brunch circuits
without service or &crier fee, 1 46.85 3{6,3$ 2
Address: PO Box 51 fast branch circuit
Each add'I branch circuit 9 _ 6.65 Sq 'Sr 2
City/ State/Z1P: Beavercreek, OR. 97004 Miscellaneous (service or feeder not included)
P or irrigation circle 53.40 2
Phone: (503) 969 -5684 I Fax: : (503) 632 -2421
Sign or outline lighting 53.40 2
E -mail: Signal circult(s) or limited -
CONTRACTOR energy panel, alteration, or
extension. Describe: Page 2 2
Business name: Clackamas Electric Inc.
Address: PO Box 51 Each additional Inspection over allowable In any of the above
Per inspection 62.50
City/ State/ZIP: Beavercreek, OR. 97004 Investigation per hour (1 hr min) 62.50
Phone: (503) 632 -2420 — 1 Fax: (503) 632 -2421 industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
CCB Lic.: 161923 I Electrical c.: 3 I Suprv. Lic.: 5041S Subtotal / 0 (0710
•
Suprv. Eleetriciai signature, required: Plan review (25% of perm* fee)
Print name: S cAw J Oimas i k a Date: 09/27/0E
State surcharge (8% of permit fbe) I, 5.4
Authorized signature: TOTAL PERMIT FEE p 1 11'5.2.4
13 This permit application expires H a permit Is not obtained within 180
days after If has been accepted as eomptete
Print name: I Date: • '• Num m ber dolethoogy of inspections set by per permit ty allo-Coun B wed uilaia8 industry swine sound
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CITY OF TIGARD
BUILDING DIVISION - PERMIT #: El -02006 00546
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/28/2.006
Phone: (503) 639 -4171 � FI
Inspection Requests (24 Hrs.): (503) 639 -4175 �i - ..
INSPECTION WORKSHEET FOR DATE: 11/29/2006 TIME: 7 :04AM PAGE: 29
SITE ADDRESS: 12587 SW 68TH AVE_ CLASS OF WORK:
SUBDIVISION: PP1996 - 024 LOT #: 001 TYPE OF USE:
PROJECT NAME: NE_IL..SON
DESCRIPTION: 10 branch circuits. 11/28/06 changed address (from 12585 68th Ave)
OWNER: NIELSON, MARK PHONE #: 503 - 582 - 5777
CONTRACTOR: CLACKAMAS. ELECTRIC INC. PHONE #: 503 -632 -2420
Inspection Request Scheduled For: Date: 11/29/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 040383-01 503- 793 -5546 N
Corrections /Comments /Instructions:
rNPC-- PSSv■•) d ANcI_ 6c.2171.6,5 ,Niv u-
•
U PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: C) (% I U i ` �9 (7J ` ' Phone #: 1 y 1 v Date: (503) 718- ��b -
CITY OF TIGARD
. BUILDING DIVISION - PERMIT #: ELC2006 -00546
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/28/2006
Phone: (503) 639 -4171 ltd
Inspection Requests (24 Hrs.): (503) 639 -4175 ...' "' —
INSPECTION WORKSHEET FOR DATE: 11/3/2006 TIME: 7:01AM PAGE: 12
/as
SITE ADDRESS: 12586 SW 68TH AVE CLASS OF WORK:
SUBDIVISION: PP1B96 - 024 LOT #: 001 TYPE OF USE:
PROJECT NAME: NEILSON
DESCRIPTION: 10 branch circuits. Neilson
OWNER: NIELSON, MARK PHONE #: 503- 582 -5777
CONTRACTOR: CLACKAMAS ELECTRIC IN . ca PHONE #: 503 - 632 -2420
Inspection Request Scheduled For: Date: 11/3/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
130 Ceiling cover 039276 -01 503-969-5684 Y
Corrections /Comments/ Instructions:
SA M,∎ ABM
1-43 u,) \I (oki:\ j eV -- {---■ N\ INA__ w.,
;'PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: \ N c) LE Date: 11 ' -' ° Phone #: (503) 718- ?AC°
CITY OF TIGARD •
BUILDING DIVISION PERMIT #: ELC2006 -00 A6
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/28/2006
Phone: (503) 639 -4171 Atal s f � l
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 11/2/2006 TIME: 7:02AM PAGE: 3
5g_1
SITE ADDRESS: 12585 SW 68TH AVE CLASS OF WORK:
SUBDIVISION: PP1996 - 024 LOT #: 001 TYPE OF USE:
PROJECT NAME: NEILSON
DESCRIPTION: 10 branch circuits. Neilson
OWNER: NIELSON, MARK PHONE #: 503 - 582.5777
CONTRACTOR: CLACKAMAS ELECTRIC INC. PHONE #: 503 - 632 -2420
Inspection Request Scheduled For: Date: 11/2/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
130 Ceiling cover 039226 -02 503-969-5684 Y
Co - ions /Commen uctions: � v, 6' `)
D•
No i (Z �
❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
A ZIL XCALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: ' 64 Lei Date:, 1 I • 2• Phone #: (503) 718- 2 �� b
CITY OF TIGARD
Y
BUILDING DIVISION " ' Alk PERMIT #: ELC200G.00546
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/20/2006
Phone: (503) 639- 4171 to
Inspection Requests (24 Hrs.): (503) 639 -4175 ... � - 11.
INSPECTION WORKSHEET FOR DATE: 10/31/2006 TIME: 7:01AM PAGE: 7
las87
SITE ADDRESS: 1250E SW 68TH AVE CLASS OF WORK:
SUBDIVISION: PP1996024 LOT #: 001 TYPE OF USE:
PROJECT NAME: NEILSON
DESCRIPTION: 10 branch circuits. Neilson
OWNER: NIELSON, MARK PHONE #: 503
CONTRACTOR: CLACKAMAS ELECTRIC INC. PHONE #: 503- 632 -2420
Inspection Request Scheduled For: Date: 10/31/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
130 Ceiling cover 039090 -01 503 -969 -5684 Y
Corrections /Comments /Instructions: I
.--sci 9
E in4.--
We pc1211,A. i 1 1 61 I ' 1 N phO tl. 1,,_
❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
A FAIL ►'� CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: V - ' Date: » l { 610 Phone #: (503) 718- 1-4111b
CITY OF TIGARD ,
BUILDING DIVISION PERMIT #: ELC2006-00546
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/28/2006
Phone: (503) 639 -4171 / ,v
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 10/5/2006 TIME: 7 :00AM PAGE: 22
/2 6 - 8 7
SITE ADDRESS: 42585 SW 68TH AVE CLASS OF WORK:
SUBDIVISION: PP1996 -024 LOT #: 001 TYPE OF USE:
PROJECT NAME: NEILSON
DESCRIPTION: 10 branch circuits. Neilson
OWNER: NIELSON, MARK PHONE #: 503 -582 -5777
CONTRACTOR: CLACKAMAS ELECTRIC INC. PHONE #: 503 -632 -2420
Inspection Request Scheduled For: Date: 10/5/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
125 Wall cover 03774401 503 - 969-5684 Y
Corrections /Comments/ Instructions:
LB b I S 1 ci
d P(koe1'ici V L t1 ..1 tkett, LAI $ 1 N11 it
ikmii1►oN'P1--_ 106e ET-Titi4 j6 ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Cr ^ I V Q3 "� Date: 1 93 i 6 Phone #: (503) 718- .2,4k___