Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2005 -00449
; . I 1 DEVELOPMENT SERVICES DATE ISSUED: 6/24/2005
'�J I� 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 25101 AD -02800
SITE ADDRESS: 12665 SW 69TH AVE 100 ZONING: MUE
SUBDIVISION: WEST PORTLAND HEIGHTS LOT : 031 JURISDICTION: TIG
Project Description: (17) branch circuits.
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: 16 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:
CEDAR ENTERPRISES ELECTRICAL DIMENSIONS INC
12665 SW 69 AVENUE PO BOX 12146
TIGARD, OR 97223 3961 N WILLAMS AVE
PORTLAND, OR 97212
Phone: 503 - 636 -6657 Phone: 503 - 282 -7255
FEES Reg #: LIC 44008
Description Date Amount SUP 2964S
ELE 26 -432C
[ELPRMT] ELC Permit 6/24/2005 $153.25
[TAX] 8% State Surcharge 6/24/2005 $12.26 REQUIRED ITEMS AND REPORTS
Total $165.51
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.
/7
Issued By: pr z ... Permittee Signature: m
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 FOR i i 1 I c I 1 I cl l_1
City of Tigard - Received � 7 P --- 7(../
�j �, F�;tNo. : E;� -�'�pd o0 /y�
13125 SW Hall Blvd., Tigard, OR 97! , plan Rev iew
ur, t1, , �; . .:; Other Perini .
�
Phone: 503.639.4171 Fax: 503.598.19' i � I , Date/By: ` G0.'5" UU � Q
Inspection Line: 503.639.4175 -'f . .. Date Ready/By: runs: ® See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: "I / U Supplemental Information
11 (T PF,w915ARD PLAN REVIEW
❑ New construction ❑ : . , I Z . y t, �
, , . ; +. ent Please check all that apply:
�� ❑Service over 225 amps, comm'l ['Hazardous location
❑ Demolition 14 Other: T
❑Service over 320 amps — rating ❑ Buildng over 10,000 sq. ft.,
CA' GORY OF • STRUCTION of 1- and 2- family dwellings 4 or more new residential
❑ 1- and 2- family dwelling m ommercial/industrial ❑ Accessory building ❑Syste over 600 volts nominal units in one structure
M ['Building over three stories ['Feeders, 400 amps or more
❑ Multi - family aster builder 0
❑Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress/lighting plan RV park
�/ S GC? ❑Health care facility ❑�
Job no.: Job site address: ( f Submit X sets of plans with any of the above.
Ci ty / State/ZIP: ' 7 f ( ' ► I O j R i f The above are not applicable to temporary construction service.
Suite/bldgiapt. no.: j (JO Project name: C_FAL9010 6R fi -r a FEE* SCHEDULE F« Tout ••
Cross street/directions to job site: New residential single- or multi - family dwelling unit.
Includes attached garage. _
1,000 sq. ft. or less 145.15 4
Subdivision: I Lot no.: Ea. add'1500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
Tax map /parcel no.: Limited energy, non - residential 75.00 2
DESCRIPTION OF - WORK Each manufactured or modular
viR [� t r—
dwelling, service and/or feeder 90.90 2
0
' l •LSO N C9 R 0 u P /z �`f rio / t l G Services or feeders installation, alteration, and/or relocation
/^ot�eil RT ' OF a c o o / 200 amps or less 80.30 2
l ❑ PROPERTY OWNER l 0 TENANT 201 amps to 400 amps 106.85 2
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
❑ APPLICANT 1 ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee, I 46.85 Wp
each branch circuit
Address: Each add'l branch circuit /6::, 6.65 ( 0(, o ,
City/ State/ZIP: Miscellaneous (service or feeder not induded)
Pump or irrigation circle 53.40 2
Phone: ( ) Fax: ( ) Sign or outline lighting 53.40 2
E-mail: - Signal circuit(s) or limited-
' CONTRACTOR energy panel, alteration, or
extension. Describe: Page 2 2
Business name: 6-[�—CrR P7 41 C..4) b it) S .
Address: �� f . /v V S"V Each additional inspection over allowable in any of the above
+ P inspection 62.50
City/ State/ZIP: g t QR d �� ! y Investigation per hour (1 hr min) 62.50
Phone: ( 2 - 5 j Fax: (�03) /g 19 Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
CCB Lic. :'T`rt✓oe Electrical Lic.: z6 -132 4, Suprv. Lic.: 2964 6 Subtotal ('-5 2.-
Suprv. Electrician signature, required: / 7 Plan review (25% of permit fee)
State surcharge (8% of permit fee) / Z,
Print name: oC3E� C SI- F _ Date: O6/z.Z /or TOTAL PERMIT FEE l6 t t
Authorized signature: 'Ibis permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: l Date: • Fee methodology set by Tri -County Building Industry Service Board
• • Number of inspections per permit allowed.
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*
❑ Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
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
CITS' \OF TIGARD _
BUILDING DIVISION PERMIT #: ELC2005 -00449
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/24/2005
Phone: (503) 639 -4171 : A „ j l l 'I
Inspection Requests (24 Hrs.): (503) 639 -4175 _ -�— W'
INSPECTION WORKSHEET FOR DATE: 7/2W2005 TIME: 7:08AM PAGE: 58
SITE ADDRESS: 12665 SW 69TH AVE 100 CLASS OF WORK:
SUBDIVISION: WEST PORTLAND HEIGHTS LOT #: 031 TYPE OF USE:
PROJECT NAME: CARLSON GROUP
DESCRIPTION: (17) branch circuits.
OWNER: CEDAR ENTERPRISES, PHONE #: 503.636.6657
CONTRACTOR: ELECTRICAL DIMENSIONS INC PHONE #: 503
Inspection Request Scheduled For: Date: 7/28/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 012287 -01 503282 -7255 N
Corrections /Comments/ Instructions:
SS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: - 71 4-1 4 1 S Date: 7 — Ze wVone #: (503) 718-