Permit CITY OF T I G A R D ELECTRICAL PERMIT
PERMIT #: ELC2004 -00037
�ll DEVELOPMENT SERVICES DATE ISSUED: 1/27/2004
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 - 4171
PARCEL: 2S112DC -01600
SITE ADDRESS: 15575 SW 74TH AVE
SUBDIVISION: FANNO CREEK ACRE TRACTS ZONING. I -P
BLOCK: LOT : 007 JURISDICTION: TIG
Project Description: Install one frestanding sign with (2) cabinets
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: 1
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: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
BOWLES, JOHN MARGARET OCHSNER ELECTRIC INC
8986 SW ARAPAHO RD 8724 SE YAMHILL ST
TUALATIN, OR 97062 PORTLAND, OR 97216
Phone: Phone: 503 - 254 -0015
Reg #: LIC 88522
ELE 26 -823C
FEES SUP 2660S
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 1/27/2004 $53.40 -
[TAX] 8% State Surcharge 1/27/2004 $4.27 Elect'I Service
Elect'I Final
Total $57.67
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: 4 . IL _/ ! „ Permit Signature: % of i„op
f ' OWNER INSTALLATION ONLY
The installation i being made on p operty 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:
Cal[ 639 -4175 by 7:OOpm for an inspection the next business day
Electrical Permit Application FOR OFFICE USE ONLY -:<
Received � Electrical C s ,,
• Date/By: I -- `
0 . Permit No.:E� D y. 000 37
City of Tigard Date/By: Approval Sign c m 1 — Permit No. JV
No
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: 503-598-1960 A, I/ ,4 Post- Review Land Use
Date /By: Case No.:
Internet: www.ci.tigard.or.us Ur0l1 c I I ,� Contact Juris.: ® See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 Name /Method: Supplemental Information.
x ' PLANREVIEW (Plea 1F
�`; � � ��`'�' �� ... ��, � �,.. ,. Ty � �Tl'PE „OF, WORK .;.. ,_... >.. . � �;:F . <s.. . x, f � � �-
Ti New construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility
® � `�� commercial ❑ Hazardous location
1 Addition/alteration/replacement Other: ❑ Service over 320 amps- rating of ❑ Building over 10,000 square feet,
µ s; R _i .' ' CATEGORY OF CONSTRTTCTIONM :, h _ yi 1 & 2 family dwellings four or more residential units in
❑ 1 & 2- Family dwelling ® Commercial/Industrial ❑ System over 600 volts nominal one structure
❑ Building over three stories ❑ Feeders, 400 amps or more
❑ Accessory Building ❑ Multi- Family ❑ Occupant Toad over 99 persons ❑ Manufactured structures or RV park
❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other:
` ' I =T7 -' ;';' JQB SIN�FO _ `RMATI ONandiOC QT I®N„ . Submit _ sets of plans with any of the above.
The above are not applicable to temporary construction service.
Job site address: /S.S75 �W s , - ; -; 74 Avg. ! , � , ;, 'FE_E *. SCHEDULE gWQ'Tr r;i . re:
.
Suite #: -I Bld' . /Apt. #: Number of inspections per permit allowed
Project Name: p,4,7 9- 2s?s� 7 Description Qty Fee (ea.) Total T
New residential - single or multi - family per ■
Cross street/Directions to job site: dwelling unit. Includes attached garage.
7 1 1 19— Mie. WGO/CAV APNir/7- Att449/1fil Service included:
// 1000 sq. ft. or less 145.15 4
Each additional 500 sq. ft. or portion thereof 33.40 1
Limited energy, residential 75.00 2
Subdivision: Lot # • Limited energy, non residential 75.00 2
Tax map /parcel #: Each manufactured home or modular dwelling .
a # -- - g -- i jp I service and/or feeder 90.90 2
.. w _ ..< . .s pESCRIPTIONOFWORK
/ _ .- Services or feeders - installation,
l u ` ( /) '�- /3 d (�� _5 (� J( . alteration or relocation:
__ /_ 666 / / 200 amps or less 80.30 2
ea, t/i�.P- 6 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
TrF__3N:0, - . . k ” - pp
EROEERTY OWNERS k 601 amps to 1000 amps
240.60 - '" ° � " "' ,q � � � " " " � ` '� Over ] 000 amps or volts 454.65 _ 2
Name: U4 cri �1 Sfic --w/ T t '' 4' Th C4.126 Reconnect only 66.85 2
Address: 5-S7 c g:w 7171:s- 48 4k1/ Temporary services or feeders - installation,
I alteration, or relocation:
City /State /Zip: "C-,,q�, b 0 R } . 9 7 Z_2_ 200 amps or less 66.85 1
l i 201 amps to 400 amps 100.30 2
Phone �lpg ,2�5 S ax: 401 to600amps 133.75 2
❑ ,A'PPLICANT ,�:q ..mss : bpieo ACT PER ,,
SON:, ,,_.: _ i Branch circuits - new, alteration, or
Name: (4:a/nice ee./Yl.. VLaErepcM extension per panel:
A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 6.65 2
City /State /Zip: B. Fee for branch circuits without purchase of
service or feeder fee, first branch circuit 46.85 2
Phone: Fax: Each additional branch circuit 6.65 2
E-mail: Misc.(Service or feeder not included):
-. - . Each pump or irrigation circle 53.40 2
,� �� AMR! C ®1vTAC'T?OR� .0 . - , �. �.i Each sign or outline lighting i 53.40 2
Job No: Signal circuit(s) or a limited energy panel,
y� /�
/ _ alteration, or extension Page 2 2 _
Business Name: , ��L St6- - .. DR. M' " Description:
Address: /52-o S , *. 7 A
q`12- Each additional inspection over the allowable in any of the a
Cit /State /Zia : ol A 012- , 2 Per inspection per hour (min. 1 hour) 62.50
Phone: 6 - 2,0 - 20 I `. ax: 4 7o 7 1 estigation fee:
CCB Lic. #: 4s Lit' S her
ZO - C L El'ectrtcal Perm►t F ee s ,�' iW
Supervising el trio .n Subtotal $ 53, w
si: ature re, ire • A , �� . , / � A £ r� Plan Review (25% of Permit Fee) $
Print Na .• e: P ►f I L r _le ► irgalif i � S ( State Surcharge (8% of Permit Fee) $ 1/, 3
I TOTAL PERMIT FEE $
Authorized — it, ' 1 J Notice: This permit application expires if a permit is not obtained within
Signature: 1 ; ai Date: 1 — Z 6't7 / 180 days after it has been accepted as complete.
_
*Fee methodology set by Tri- County Building Industry Service Board.
6T 4 U:(i -? 1 (
(Please print name)
is \Dsts\Permit Forms \ElcPermitApp.doc 01/03
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
•
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
•Fee for all systems $75.00
Check Type of Work Involved:
• n Audio and Stereo Systems
n Burglar Alarm
ri Garage Door Opener
Li Heating, Ventilation and Air Conditioning System
•
n Vacuum Systems
Other
COMMERCIAL WORK ONLY:
Fee for each system $75.00
(SEE OAR 918 - 260 -260)
Check Type of Work Involved:
n , Audio and Stereo Systems
•
r i Boiler Controls
n Clock Systems
n Data Telecommunication Installation
(n Fire Alarm Installation
n HVAC
n Instrumentation
n Intercom and Paging Systems
n Landscape Irrigation Control
ri Medical
n Nurse Calls
Outdoor Landscape Lighting
Protective Signaling
Other
Number of Systems
* No licenses are required. Licenses are required for all
other installations
•
i:\Dsts\Permit Forms\ElcPermitAppPg2.doc 01/03
08/25/04 04:37 FAX 001
CITY OF TIGARD
13126 S.W. HALL BLVD.
TIGARD, OR 87223
IMPORTANT PERMIT NOTICE
OCHSNER ELECTRIC INC
8724 SE YAMHILL ST
PORTLAND, OR 97216
Electrical Signature Form
Permit #: ELC2004.00037
pate Issued: 1/2712004
Parcel: 2S112DC -01 600
Site Address: 15576 SW •74TH AVE
Subdivision: FANNO CREEK ACRE TRACTS
Block Lot 007
Jurisdiction: TIa '
Zoning: 1 -P
Remarks: Install one freetandIng sign with (2) cabinets
Your company has been indicated as the electrical contractor for the permit Indicated above. In order for
the electrical permit to be valid, the signature of the supervising electrician is required. Please have the
appropriate individual from your company sign below and return this Electrical Signature Form prior to the
start of the work to the address above, ATTN: Building Division.
No eleotriaellnaplictlone will be authorized until this completed form Is received
OWNER: ELECTRICAL CONTRACTOR:
BOWLES, JOHN MARGARET OCHSNER ELECTRIC INC
8986 SW ARAPAHO RD 8724 SE VAMH1LL ST
TUALATIN, OR 97062 PORTLAND, OR 97216
Phone #: Phone #: 503- 254 -0015
Reg #: LIC 9 522
ELH 26 -4230
SUP 2660S
AN INK SIGNATURE IS REQUIR ON THIS ORM
Si ature of Supervising Electrician
If you have arty questions, please call 503.719.2433. / // �
5b 3- _ 3f� O /
10/T0 39dd Id3Q EJNI0-1IfH CalVDI1 T89EIZ9E05 L5 :60 b00L /OZ /80
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 MST
INSPECTION DIVISION Business Line: ` (50) 639 -4171
F BUP
Received Date Requested D ��-�p AM PM BUP
/
Location / 5 -C Pt-o--e-- Suite MEC
Contact Person ___ _ Ph ( ) g F 7 (e O p Z PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC oRe)e q — 600 7
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Ext Shear Sheath/Shear S _.7�
Ext w
Int Sheath /Shear _
Framing
Insulation , 1 /1 —
Drywall Nailing (f2 l� F �/ �
Firewall
Fire Sprinkler l
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
CA
Low Voltage
Fire Alarm
ina Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
ORO PART FAIL
Please call for reinspection RE: ❑ Unable to inspect — no access
Fire ADASupply Line t C . I/, 4-ppLemek App roach /Sidewalk Date Inspector [(� Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL