Permit - tTY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2002 -00527
A l i DEVELOPMENT SERVICES DATE ISSUED: 10/10/02
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S111AC -02700
SITE ADDRESS: 14650 SW 97TH AVE
ZONING: R -4.5
SUBDIVISION:
I BLOCK: LOT : 037 JURISDICTION: TIG
Project Description: Placement and anchoring of electrical equipment only. (WACO master program member)
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: 1
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:
TIGARD/TUALATIN SCHOOL DISTRICT OWNER
6960 SW SANDBERG
TIGARD, OR 97223
Phone: 503 - 431 -4000 Phone:
Reg #:
FEES
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 10/10/02 $62.50
[TAX] 8% State Tax 10/10/02 $5.00 Elect'I Final
Total $67.50
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" or more thar\180 days. ATTENTION: Oregon law requires you to follow rules ado ted by the Oregon Utility Notification Center. Those
rulesare set forth in OAR 9. 001 -0010 through OAR 952 - 001 -0100. You may obtain copies o se rules dir questions to OUNC at (503)
246 699 or 1.800- 332 -2344. ,
Iss ed By: , Lk V,14 711 , Permit 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 639 -4175 by 7:00pm for an inspection the next business day
1
I
�� ec�Cal Permit App 7.on - . OFFIC use ca 1.
Date received: /1 /0 Q� Permit no.: e J'�r,,., .05A
„ r� j r Ci of Tigard Project/appl. no.: Expire date:
Ciry of Tigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Date issued: By: Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 - 1960 Case file no.: Payment type:
Land use approval:
- 1 - 11'F. OF P I
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family ❑ Tenant improvement
❑ New construction ❑ Addition/alteration/replacement ❑ Other: Cl Partial
• JOB SITE I\FOR:MATION
sf-• 'Job address: /4// 'u1 .7 t` / _ _ Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: I Block: I Subdivision:
Project name: Description and location of work on premises: li_ge7,e / e / 1 -L /,J i r /2,4 -e. u i PP_
Estimated date of completion/inspection: , ' ,or AdernI r • . . - CONTRAC:I :OR APPLICATION . FEE •SClIF )LLE>
Job no: Fee Max
Business name: K. ) k.- Description Qty. (ea.) Total no.insp
New residential- smgleor multi-family per
Address: dweuingmtit . Includes attachedgarage.
City: State: ZIP: Service included:
Phone: Fax: E - mail: 1000 sq. ft. or less 4
CCB no.: Elec. bus. lic. no: Each additional 500 sq. ft. or portion thereof
. Limited energy, residential 2
City/metro lic. no.: Limited energy, non - residential 2
Each manufactured home or modular dwelling
Signature of supervising electrician (required) Date Service and/or feeder 2
Sup. elect name (print): License no: Services or feeders— installation,
alteration or relocation:
• . PR OPE R T Y OWNER' . ' 200 amps or less 2
Name (print)Tl eti TtA4LiTlJ 6/51-2,zi 201 amps to 400 amps 2
Mailing address: (,o kD 5 W SA NA ' "I9 401 amps to 600 amps 2
601 amps to 1000 amps 2
City: ria4,24, State:02 ZIP? 2Z3 Over 1000 amps or volts 2
Phone:S.23 14 3/ 1 o I Fax: E -mail: Reconnect only 1
Owner installation: The installation is being made on property I own Temporary services or feeders -
which is not intended for sale, lease, rent, or exchange according to installation, alteration, orrelocation:
ORS 447, 455, 479, 670, 701. 200 amps or less 2
201 amps to 400 amps 2
Owner's signature: Date: 401 to 600 am s 2
Branch circuits - new, alteration,
or extension per panel:
Name. A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
City: State: ZIP: B. Fee for branch circuits without purchase
of service or feeder fee, first branch circuit: 2
Phone: Fax: E Each additional branch circuit:
. PLAN REVI[11' (Please check all that apply) : Misc. (Service or feeder not included):
❑ Service over 225 amps - commercial ❑ Health -care facility Each pump or irrigation circle 2
❑ Service over 320 amps -rating of 1 &2 ❑ Hazardous location Each sign or outline lighting 2
family dwellings ❑ Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
❑ System over 600 volts nominal more residential units in one structure alteration, or extension* 2
❑ Building over three stories ❑ Feeders, 400 amps or more *Description:
❑ Occupant load over 99 persons ❑ Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
❑ Egress/lighting plan ❑ Other: Per inspection I I I I I &A so
Submit sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other /
Not all j urisdictions accept credit cards, please call jurisdiction for more information. Permit fee $ 6 2 C�
1 P P jurisdiction N otice: This permit application
❑ Visa ❑ MasterCard expires if a permit is not obtained Plan review (at %) $
Credit card number. / / within 180 days after it has been State surcharge (8 %) $ 5, d d
Expires TOTAL $ ' 7
accepted as complete.
Name of cardholder as shown on credit card
$
Cardholder signature Amount 440 -4615 (6 /00 /COM)
Cca C 'NONE 5 U3 y3 I HO19
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