Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2005 -00719
DEVELOPMENT SERVICES
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DATE ISSUED: 9/26/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S 104AD - R - O - W
SITE ADDRESS: SW NO ADDRESS ZONING:
SUBDIVISION: LOT : JURISDICTION: TIG
Project Description: Connect underground power supply. g ork`is being done across from 12600 SW Walnut Job No. 1526
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: 1 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:
CITY OF TIGARD EMPIRE ELECTRIC COMPANY
13125 SW HALL BLVD 2014 SE 9TH AVE
TIGARD, OR 97223 PORTLAND, OR 97214
Phone: 503 - 639 -4171 Phone: 503 - 777 -3108
FEES Reg #: LIC 147727
ELE 3-521C
Description Date Amount SUP 3192S
[ELPRMT] ELC Permit 9/26/2005 $80.30
[TAX] 8% State Surcharge 9/26/2005 $6.42 REQUIRED ITEMS AND REPORTS
Total $86.72
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 80 32- 4 4.
Issued By Permittee Signatur •
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:
• NTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: �!' �. /�.�tI!��h 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.
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Elm.1t1 Pmrmit AB1151 2 3FIVE0 FOR OFFICE 1,S111) L,1'
City of Tigard Received 9 0 I MI. p.mattla.; E , , 45=6 /
Date/B : , .-
13125 SW Hall Blvd...11VA. OK 97223 '
- ian Review '
Phone: 03.639.4171 Fix; 503.598.1960 SEP 2 3 2005 ..,. 44 . i . ''.2.,4 \ Dmig , Other Pornau
lospeosion Line: 503.639,4175 4+91/- ' 't I Dare .. .ln : yr . EgfEEENI
Internee www.eillgard.or.us CITY OF TIGA '' '.'“ — - riouteciimiaod ! c C
7=7.. I.: :11r•w• : it 'i '0-- '' ".
T 14''' '
El Now construction riTrddition/alteration/replaccuteut Please check all that apply:
°service over 725 amps, contrail 1:1Havednu location
0 poinolition 0 Other: ___ °Service over 320 amps - rating Diauildng over 10.000 SQ, 11..
, ,1,..,', :::;:;.;,;..; ';'1 .;:i0 300Ntii'Vre.rte ..:: :'*;:'!: i..: E.. .:...:- ;:::ititteff of 1. ;A 2-faritity dwellings 4 or Moro new residential
C:1 is and 2-farstily dwelling IL: •nunereiallindustrial III Ace building °system over 600 volt nominal units in one structure
°Building over three Marto I:Weeders. 400 amps or more
O Mai-fraii 0 Master bonder CI Other; IZIOceupant load over 99 pawns CIManufactured structures or -
?'‘ ..',J, .41: l';'; i; ?' 0. ...:..° '.::..:..°.. ° 1 . '. S 0 Erd: Plan RV park
OHcalth-eam facility 0001er:
kb no.: <2 Cs Job site istldress: A Celi9S { t7J6 40 Submit 3, seek of plans with say of the above.
City/State/4TP: - 1 - 7 p., r d 0 • 7 . e , The above are not applicable to temporary construction service.
I:
Suite/bldg /apt no
f, :y7. •:.....; .:,. • • . . •
project ewe! C i2L„..).2::‘, ( ......0. :, . , . . . . . qv. i . ...,.: ,, . t .... i ... . ........
• 'vq1 _ ---:' Plrig . ' &Ms - • • •••• .. . .• , • .., 1 - .
.- .: 7
Crass street/directions to Job site: New maldentiol single- or multi-family dwelling unit.
--.---- .................... --•••••• !octanes attached tante- . --
1,000 sq. ft- or less _ 145.15 . 4
Subdivision: Lot no.: Es. aril 500 q. R. of ot__,....0._.......prrrei i
' ,Limited energy, residential 75.00 2
Tax ono/parcel no.: 01 A`z) -1 cc) _ Limited ater , nen Idenderes 2
;IR 4?';::: :::::i00ii■I' 1 iilrl.i:' '."..:!'! IllS.,';!....'.....D 1 :li P.A.S • :*.': '-' •;..: :: End roanaTaeicrucl er modular
CO V■ VI Q. Cr U G Fc, v./ .L.,/ Cr k 4Weillnalldi" reedCr 90.90 2 .
s erv i ces ar feeders Instaltation, alteration. andier reloca tion •
200 amps or le.sa 80.10 . 6 O 0 2
mg 106.85 2
05'..2.. 41.7.4.0140,41.1.: f] 1
t :... 2°1 . 63 4°°3mPs
• 401 amp to 600 amps 111 160.60 2
Warne: 601 a .5 so 1,000 amps 240,60 11 2
. . _
Address; Over 1,000 amps or volts 454.65 EMI 7
- — - . Reconnect only 6615 2
ZTP: Temporary services or feeders Installation, alteration, ottd/or
Ci - 0 : ( cl ) ax: ( )
ph reiocition
200 arms or lets 66.85 I
Owner installetion: This inrnaltaxion is being made Oil property that I Own villich is not 201 amps to 49 antra 100.30 . • 2
inrended for sale. Jesse, rent, or c.tehange, according to ORS 447, 449, 670, and 701. 401 amps to 600 arts_ 133.75 2
Owner signature; T . Date: ariuyeti circuity - new, alteration; or extension, per panel
:?::::: ,,,,,' ...11001. a : ., ,. .. A. for ttraniti cizeuitS With
... .. , .,,. . ,. . . . .
6.65 2
plibinerg none: ,...... Kr % r . 4 2,..., 0 eze -r, i 4 ___ branch circuit
- '"" R. Fee for brumhcirtuits
Contact name: " wallow service or tt-eder lee. 46.8S 2
each branch circuit
Address: Each addltrrarich, circuit 6.65 2
- - .....-- '
City/State/ZIP; 14,1seslisnosas (sti-41e* or (wide not tooltitied)
- Pump or irrigation Welt 53.40 ' 2
Phone: ( ) Fax: : ( ) . sign or outline lighting 53.40 2
....,
E-mail: Signal eircult(s) or limite4-
d.0.!!0;:::. :., .. !.,.'.'•:::•'•:.:. .... ' 0:: . Pit°41t:;:ilit .-: ' 'i".:. if! . • • ''' ::• ".:':•! ::•'..:i.:...;' -CINITOY panel, iherati°". c '''
ascension. Descrilse: Page 2 2
Business nom: sei.--. r i - eik.e..... (1 i , — ... __
Address: -z 0 1 ti 5 C 9 T A ip___ Each additional Inspection over allowable In any of the above
......._.-- Per inspection
.. . ,
City/State/ZIP: p„,,,T( nc cp? z ( 2-f inve.d per hour (I rid mad 62.50
7
---..m.
industital plant hour 73.75
Phone: (c0 ) 7 7 7 - 310 8 • t I Fax; ( 1413 ) 77? le s-z. ,,,,,,,,,,. --E . I EMIT IrEES.." ' - •
.14 .ECTRIC.Ali PE 1. • . 1 : -'' . • • • •
CCD Lie.; 14{77 2. 7 Electrical Lie.: 3 czt e..._ & Lie.: J 1 -6 (p 5 • Subtotal c iS 03
Suprv. Electrician siguattire. requiled: :Ap ' / _ • Plan review (25% of parfait Te /. 4 /
i - State surcharge (13% of permit fee). .....6-12% k•M ../ 2"
Print mime: D : t. . 80fr,:iie, . 5.0.
TOTAL PERMIT FEE
Dace; / 7510
Authorized signature: - This permit 1111Salkadoa aspires If permit Is not obis/wed within 140
•-...--- der after II to been Kamm' as earstalete
Print name: iI3 • Fcc nwthudology set by Td-County Buddies Industry Service used
i...----- '" Number or usinction$ pet penult alloYsd.
iAllui4i54TOVIW2LOPinnilAW4oc 0/01 410
Td WUES:e)T SOOE 2E •dS ESTVLLL2OS: ON XIiJ 03 DIal3313 aelIdW3: woaA
'CITi( OF TIGARD
BUILDING DIVISION ' 0s. PERMIT #: ELt 200 x0071'
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/26/2005 Phone: (503) 639 -4171 v /4 al
Inspection Requests (24 Hrs.): (503) 639 -4175 IIL.
INSPECTION WORKSHEET FOR DATE: 9/28/2005 TIME: 7 :08AIVl PAGE: $
SITE ADDRESS: NO ADDRESS CLASS OF WORK:
SW SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: COMCAST CABLE
DESCRIPTION: Connect underground power supply. Work is being done across from 12600 SW Walnut. Job No.
1526
OWNER: CITY OF 'TIGARD, PHONE #: 503.639 -4171
CONTRACTOR: EMPIRE ELECTRIC COMPANY PHONE #: 503- 777 -3108
Inspection Request Scheduled For: Date: 9 0/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 016773 -01 503- 777 -3108 Y
Corrections /Comments /Instructions: say'
N PASS ❑ PARTIAL APPROVAL n CANCEL n NO ACCESS
A IL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: A Q,. U IV o LE Date: C 76 ---- Phone #: (503) 718- 2''/11`