Permit — - ELECTRICAL PERMIT
Y "0 TIGAR
PERMIT #: ELC2003 -00257
��,� DEVELOPMENT SERVICES DATE ISSUED: 5/19/03
`- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S111AC
SITE ADDRESS: 14650 SW 97TH AVE
SUBDIVISION: TIGARDVILLE HEIGHTS ZONING: R-4.5
BLOCK: LOT : 037 JURISDICTION: TIG
Project Description: Installation of (3) branch circuits for (3) new roof top units. L3 /4 /04.,_reinstated as mechanical pern'it)
wa lust approved or issuance --/
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: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 2 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 DIST #23J OWNER
6960 SW SANDBURG ST
TIGARD, OR 97223
•
Phone: 503 437 - 4048 Phone:
Reg #:
FEES
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 5/19/03 $60.15
[TAX] 8% State Tax 5/19/03 $4.80 Rough -in
Elect'I Final
Total $64.95
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 a. - • : s. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set
forth • OAR 952 - 001 -0i • through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503) 246 -6699 or
1 -; d0- 332 -2344.
•
Is . ued By: - ! _ �`__ Permit Signature:
AO-a 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
I
Eljctrical Penult %AppL c tion ,. , F.OR OFFICE USE. ONLY :, -- • • -
- Received d 2 Electrical �
s `� — Date/By: 0 3 Permit No.: -00 ,35'7
City of Tigard Mg( 0 tq 2003
Date/By: Planning Approval Sig
/ Date /B Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 CITY OF TIGARD Date /By: Permit No.:
w
Phone: 503- 639 -4171 6 F L1 5 j 4,'�'-�S p.Awo / 0 � t,i It Use
Date /By Re Case Land Use
Internet: www.ci.tigard.or.us � j I1 Contact J ® See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 ' ' W Name /Method: / • Supplemental Information.
' :. ' �;, .fix' :; .. a" `° r' s ..`tIfe i . '
:: �E��' �,°` ,:o�a.TYEE,OFW.ORK� := z '��.��,��� >,:�i=r `::�� . r ,��:�';�iPLAN= °REVIEW(El' ease`: ctieck�a11�t6at.aPPiy)..R,.�.,. .� ry. _ - =:�,
❑ New construction ❑ Demolition � ❑ Service over 225 amps- ❑ Health -care facility
commercial ❑ Hazardous location
❑ Addition/alteration/replacement ❑ Other: ❑ Service over 320 amps- rating of ❑ Building over 10,000 square feet,
' : pr "' CATEGORY OF t" ` _� 0'=" ' -' 1 & 2 family dwellings four or more residential units in
❑ 1 & 2- Family dwelling [T ommercial/Industrial 1=1 System over 600 volts nominal one structure
❑ Building over three stories ❑ Feeders, 400 amps or more
❑ Accessory Building ❑ Multi- Family ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
❑ Master Builder ❑ Other: ❑ plan ❑ Other:
, ,., x - = ... -..__ , _.__.._.. ,, µ r- Submit sets of plans with any of the above.
Egress/lighting
1.-14M ODISITE INFO and LOCATION . i ;E;
The above are not applicable to temporary construction service.
/ htv5 £C L) r c
Job site address: +ld '` �- C lrialM ath; anE *,SC�HED`I1IyE'41 .. .,:rr''_.'gaMiM , ;
Suite #: Bldg. /Apt. #: Number of inspections per permit allowed
Project Name: ) 4 1,',L kcal cci/ - Description Qty Fee (ea.) Total 1
New residential - single or multi - family per
Cross street/Directions to j96 site: dwelling unit. Includes attached garage.
C i 4 - k � � Service included:
VVVCCCJJ� 1000 sq. ft. or less 145.15 4
Each additional 500 sq. ft. or portion thereof 33.40 I
Limited energy, residential 75.00 2
Subdivision: Lot #: Limited energy, non residential 75.00 2
Tax map /parcel # Each manufactured home or modular dwelling
' DESCRI OF WORK tk f R w: ` " service and/or feeder 90.90 2
�` �' ' ` °�" _ Services or feeders - installation,
Lag QJ ` � C• Q--Q 4_ J - - "f' /4C) • alteration or relocation:
Gc4.)
C
200 amps or less 80.30 2
201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
601 amps to 1000 amps
240.60 2
Li El 1PRQM04IO WNER . _ :I TENAN:t ., ,... '.a . p p
c, A.4>_,6 ^ ( R amps or volts 454.65 2
Name: u : A t- ,A Reconnect nnect nett only 66.85 2
Address: (, 7 O S, (-, . "k e ms bt.t -P c S . Temporary services or feeders - installation,
( - alteration, or relocation:
City/State/Zip: C,a, \ C)1._ ° L - i aa3 200 amps or less 66.85 1
Phone: SO C( 201 amps to 400 amps 100.30 2
3 3/ yv��� Fax: 431 �0,,�6
:i€ � ., � 401 to 600 amps 133.75 2
APP IICANT, A i x , is �_ ,t,3; gR GOIYTACT : PER S O.N ` , ; ,
� ' I Branch circuits - new, alteration, or
Name �A S �l, y/L_ extension per panel:
A. Fee
C' S�. branch circuits with purchase of
Address: 6 _ .-<_, S)4� (St,�Z ( service or feeder fee, each d e branch circuit 6.65 ,/ 2
City /State /Zip: CP>r'\ c c ? ,P 0)-3 B. Fee for branch circuits without purchase of 4�'� v
service or feeder fe First branch circuit / 46.85
2
Phone: --I-L. l - it c2 Fax: 5 -- Ct 3/ - ova G Each additional branch circuit '� 6.65 1 . 00 2 x2
E -mail: Misc.(Service or feeder not included):
„� �__ a �, # e � ,, Eac pump s or r outl irri g ation circle 53.40 2
_, -,_ •, �,:,GQN�TRAC a� .,,- Eh i o ine h 53.40 2
Job No: �')Lt�N Signal circuit(s) or a limited energy panel,
A alteration, or extension Page 2 2
Business Name: TC �11w4L- -41-J( u�S . Description:
Address: 676 6 S,C,J, k,i \Gt.(Zz`.
City /State /Zip: c,t>� -A �_ �7>�a3 Each din per inspection ourm. over o he allowable in any of the above: .50
Per inspection r how min. 1 hour) 62.50
Phone: 5o2 -'-t - eo ce 8 - Fax: 5o3--c-ti - LW G Investigation fee:
CCB Lic. #: Lic. #: Other:
;` it s,Electrical Nrmlt=Eees* ... l
Supervising elec'l cian \ - I - Subtotal $ ( pO • l
signature requires" I i 1 ' (-G \ \ n Ot- CA-- Plan Review (25% of Permit Fee) $
■
Print Name: ' t2 s . , , Lic. #: 6 1 -_ es State Surcharge (8% of Permit Fee) $ .. e O
TOTAL PERMIT FEE $ (D 4 r 9 6
Authoriz . . Notice: This permit application expires if a permit is not obtained within
Signatur:l I � t -1 T2 Date: 5°- O '7 -C3 180 days after it has been accepted as complete.
*Fe metho ology set,b . Iri -Count utld g Ind try Service Board.
` (Please print name) 7 � / p /L
i:\Dsts\Permit Forms \ElcPermitApp.doc 01/03 L p � , e► / L -t" -
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
n Garage Door Opener
n Heating, Ventilation and Air Conditioning System
n Vacuum Systems
n 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
n Boiler Controls
n Clock Systems
ri Data Telecommunication Installation
Ti Fire Alarm Installation
n 1-IVAC
ri Instrumentation
n Intercom and Paging Systems
n Landscape Irrigation Control
ri Medical
n Nurse Calls
n Outdoor Landscape Lighting
n Protective Signaling
n Other
Number of Systems
* No licenses are required. Licenses are required for all
other installations
i:\Dsts\Permit Forms\ElcPermitAppPg2.doc 01/03