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Permit
C ITY OF TIGARD ELECTRICAL PERMIT i - • � PERMIT #: ELC2005 -00541 E tft:i DEVELOPMENT SERVICES DATE ISSUED: 7/29/2005 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 1S135DC-02000 SITE ADDRESS: 11865 SW 91ST AVE OFFICE ZONING: R - 7 SUBDIVISION: GREENBURG OAKS APARTMENTS LOT : JURISDICTION: TIG Project Description: Temp power pole to construction trailer & (2) circuits. • RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS 1000 SF OR LESS: 0 - 200 amp: 1 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: 2 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: • VILLA LA PAZ LIMTED PARTNERSHIP M & M ELECTRICAL SERVICE INC. BY COMMUNITY PARTNERS FOR PO BOX 33706 AFFORDABLE HOUSING INC PORTLAND, OR 97292 . TIGARD, OR 97281 Phone: 503 - 968 -2724 Phone: 503- 771 -8200 FEES Reg #: LIC 161691 ELE 26 -1231C Description Date Amount SUP 4921 S [ELPRMT] ELC Permit 7/29/2005 $80.15 [TAX] 8% State Surcharge 7/29/2005 $6.41 REQUIRED ITEMS AND REPORTS • Total $86.56 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- 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. • Electrical Permit Application FOR OFFICE USE ONLY + City of Tigard RDeaze/Be. Permit No.. 0 )05'' A `'--( i 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Phone: 503.639.4171 Fax: 503.598.1960 ��" "J ' +,'v WI , Date/By. Other Permit: Inspection Line: 503.639.4175 a�.j " 1 1.1 Date Ready/By: IIIM ® See Page 2 for Internet: www.ci.tigard.or.us • J Notified/Method: Supplemental Information TYPE OF WORK PLAN REVIEW ❑ New construction ❑ Addition /alteration/replacement Please check all that apply: ❑Service over 225 amps, comm'l ['Hazardous location ❑ Demolition Other: /� _ 4 4.41.0/CS -mow/ C2-- 0 Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft., CATEGORY OF CONSTRUCTION of I- and 2- family dwellings 4 or more new residential ❑ 1- and 2- family dwelling Commercial /industrial A Accessory building OSystem over 600 volts nominal units in one structure ❑ Multi- family ❑ Master builder ❑ Other: ❑Building over three stories ❑Feeders, 400 amps or more • DOccupant load over 99 persons 0 Manufactured structures or JOB SITE INFORMATION AND LOCATION - RV park ❑E gress/lighting plan P Job no.: / S W Sr Job site address: 0 Health-care facility ❑Other: 7—/6 / / / e- Submit 2 sets of plans with any of the above. City /State /ZIP: a ,-� 0 v 722- -. The above are not applicable to temporary construction service. • Suite/bldg. /apt. no.: Project name: FEE* SCHEDULE • Description I Qty. I Fee. I Total 1 ** Cross street/directions to job site: ej / r S ree p) 6 New residential single- or multi- family dwelling unit. / l 2rc Includes attached garage. Gres— l �-`t -t 0 4Lb /4it — 6 rOC 0, S / 0 01 1,000 sq. ft. or less 145.15 4 Subdivision: / Lot no.: Ea. add'l 500 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 n"? e- c --(7. J / G /Y j ,a, id w e_p� /43, dwelling, service and/or feeder 90.90 2 j� ` L Services or feeders installation, alteration, and /or relocation c o s �e ci'"io 7��a. �t f7 Z. o po // A'/�r cvl�16)( 200 amps or less 80.30 2 . ❑ .PROPERTY OWNER ❑ 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, a d /or relocation Phone: ( ) Fax: ( ) 200 amps or less 66.85 I 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 pane ❑ APPLICANT ❑ CONTACT PERSON A Fee for branch circuits with ' .+ service or feeder fee, each Business name: branch circuit 6.65 /2 B. Fee for branch circuits ...___..-" Contact name: without service or feeder fee, 46.85 2 Address: each branch circuit Each add'I branch circuit 6.65 2 City/State/ZIP: Miscellaneous (service or feeder not included) Pump or irrigation circle 53.40 2 Phone: ( ) Fax: : ( ) Sign or outline lighting 53.40 2 E -mail: Signal circuit(s) or limited - �O " CONTRACTOR — panel, alteration, or r — // extension. Describe: Page 2 2 Business name: /� e /'l ' CT/7 /t/10? C ) Address: PO x 1 6 3 3 Each additional inspection over allowable in any of the above Per inspection 62.50 --- City /State /ZIP: Po ir/ 7(j n ( 02 q 7Z 9'z. Investigation per hour (1 hr min) 62.50 9 " 'hone. : ( o3 ) 77 8'5-DO Fax: ( ) Industrial plant per hour 73.75 O ELECTRICAL .PERMIT FEES* , 4 CCB Lic.: /6/ 0 / Electrical Lic.: 26 - /f,3 / Suprv. Lie.: zi 12 I S Subtotal j J , O "76 f Suprv. Electrician signature, required: 4nj, ,4- Plan review (25% of permit fee) / r State surcharge (8% of permit fee) J © / Print name: /�A' a cis P-7 i �hGf e / Date: a 7 `Z� ' �� TOTAL PERMIT FEE -7 Authorized signature: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete Print name: Date: * Fee methodology set by Tri- County Building Industry Service Board ** Number of inspections per permit allowed. is \ Building \Permits\ELC -Peron itApp.doc 12103 440- 4615T(10/02/COM/WEB g Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: F RE WORK". ONLY; t 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: C OMMERCIAL 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 • ❑ C lock Systems ❑ Data Telecommunication Installation ❑ F ire Alarm Installation ❑ HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ M edical ❑ N urse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling ❑ Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations i:\ Building \Permits\ELC- PennitApp.doc 04/03 -CI' Y OF TIGARD � I BUILDING DIVISION PERMIT #: El.t<2005-0054 1 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/23/20055 Phone: (503) 639 -4171 Fis i vmplJ iii Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 8/4/2005 TIME: 7:08AM PAGE: 38 SITE ADDRESS: 11865 SW 91ST AVE OFFICE CLASS OF WORK: SUBDIVISION: GREENBURG OAKS APARTMENTS LOT #: TYPE OF USE: PROJECT NAME: GREENBURG OAKS APTS DESCRIPTION: Temp power pole to construction trailer & (2) circuits. OWNER: VILLA LA PAZ LIMTED PARTNERSHIP, PHONE #: 5O3 -968 -2724 CONTRACTOR: M & M ELECTRICAL SERVICE INC. PHONE #: 503- 771 -8200 Inspection Request Scheduled For: Date: 8/4/2005 Pour Time: Code # Ins. - ••-.- : - • • '. Confirm # Contact # Message i 110 Temporary electrical se 012822 -01 603.806 -6107 N Corrections /Comments / Instructions: • 'ASS El PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS n FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: 9 519 4 4 Date: T — OS Phone #: (503) 718-