Permit !i` CITY OF TIGARD ELECTRICAL PERMIT
\ PERMIT #: ELC2005 -00425
ei i DEVELOP M ERV 503 - 639 -4171 DATE ISSUED: 6/17/2005
PARCEL: 1S135CB-R-O-W
SITE ADDRESS: SW NO ADDRESS ZONING:
SUBDIVISION: LOT : JURISDICTION: TIG
Project Description: Replace existing private vault and valves. Work is taking place near intersection of SW Tiedeman and SW North
Dakota. Job No. 2379
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:
CITY OF TIGARD RED HILLS ELECTRIC & TOWER SERVICES
13125 SW HALL BLVD PO BOX 490
TIGARD, OR 97223 DUNDEE, OR 97115
Phone: 503 6394171 Phone: 503 - 554 -8244
FEES Reg #: LIC 134593
SUP 4390S
Description Date Amount ELE 36 -84C
[ELPRMT] ELC Permit 6/17/2005 $60.15
[TAX] 8% State Surcharge 6/17/2005 $4.81 REQUIRED ITEMS AND REPORTS
Total $64.96
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
suspe d for more - 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those
rules re set forth in OAR :52 -' -t01. rough OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions t OUNC at
503- 46 -6699 or 1- 800 -33 344.
Issu d By: y 4;f4 y: , _ � � LL �I� � Permi ttee Signature: 4 4 4,..../
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: nn DATE:
CONTRACTOR INSTALLATION ONLY 6/7,75----
SIGNATURE OF SUPR. ELEC'N: G���� . O -ct- 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 OF FICE USE ONLY .
Cl O Tigard
Received
Permit No.:
Date/B : ��l/,�i.�7�7 ",• a aS
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 - / " /, 1 - `- , Date/B . Other Permit:
Inspection Line: 503.639.4175 _... Date Ready/By: • ® See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
:TYPE OF WORK PLAN REVIEW
❑ New construction ®' Addition/alteration/replacement Please check all that apply:
01 Demolition ❑Other: ID Service over 225 amps, comm'l ❑Hazardous location
❑ Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
• CATEGO1 Y OF CONSTRUCTION of I - and 2- family dwellings 4 or more new residential
❑ I - and 2 family dwelling L�JCommercial /industrial ❑ Accessory building El System over 600 volts nominal units in one structure
['Building over three stories ❑Feeders, 400 amps or more
El Multi - family 0 Master builder 0 Other
DOccupant load over 99 persons ❑Manufactured structures or
. JOB SITE INFORMATION AND LOCATION ❑Egress/lighting plan RV park
�
I ❑Health -care facility ❑Other:
Job no.: 3 7e Job site address: 5 F - De... d - Ab44-A Submit 2 sets of plans with any of the above.
City /State /ZIP: — i G A i2 The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: Project name: FEE* SCHEDULE ,
7! E 3�H 1/ / , ." i/4 .'tT Description I Qty. I Fee. I Total I **
Cross street/directions to job site: / 7 1� c �� �` R � New residential single- or multi - family dwelling unit.
CS Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
/ dwelling, service and/or feeder 90.90 2
�(Jlraed� E s
x r» r�q PR U (i�
(//4-4 4 UOt ((/tf f Services or feeders installation, alteration, and /or relocation
a / 200 amps or less 80.30 2
❑ PROPERTY OWNER I .0 TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: (I 4 - 1 ey 1" a. /4 2_ 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, and /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 panel
❑ APPLICANT ' ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: branch circuit
Contact name: B. Fee for branch circuits
without service or feeder fee
Address: each branch circuit / 46.85 46 .� 2
Each add'I branch circuit 2 6.65 /5. 30 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 -
CONTRACTOR energy panel, alteration, or
•
' extension. Describe: Page 2 2
• Business name: RE 1 1 i V S C z 6,,,c / �i r .<
Address: (TD Q Each additional inspection over allowable in any of the above
t O Ez7 , L7 ! 0 Per inspection 62.50
City /State/ZIP: � c_1 r /C 7 ' 7/7 ' Investigation per hour (1 hr min) 62.50
er Phone: (Sa3) cJ s-y _ g 2 N a Fax: (6-03) / i 7 . 3 5 Industrial plant p ELECTRICAL hour 73.75
.7 �G /- LECTRICAL PERMIT FEES*
•
CCB Lie.: l . 9 g Electrical Lie.: 36._ 634q C Sup v. Lie.: 1/,39"0 s — Subtotal '®
Suprv. Electrician signature, required: ) . / / jf Plan review (25% of permit fee)
I !s� ✓J State surcharge (8% of permit fee) '/• ''r
Print name: a)1 l f t et ..� 4 . pie G y Date: of /7 /G".� TOTAL PERMIT FEE 4J, v Authorized signature: This permit application expires if a permit is not obtaansed / 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.
1:\ Building \Permits\ELC- PermitApp.doc 12/03 440- 4615T(10 /02/COM/WEB
Electrical Permit Application - City of Tigard - a'
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY;
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:
COMMERCIAL WORK ONLY:
Fee for each commercial system $75.00
(SEE OAR 91 8- 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
Pr
❑ Medical l •
❑ Nurse 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
CITY OF TIGARD
BUILDING DIVISION
PERMIT #: ELC2005-00425
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/17/2005
Phone: (503) 639-4171 b oo k optiiii
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 6/27/2005 TIME: 7:09AM PAGE: 52
SITE ADDRESS: SW NO ADDRESS CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: CITY OF TIGARD -
DESCRIPTION: Replace existing private vault and valves. Work is taking place near intersection of SW Tiedeman
and SW North Dakota. Job No. 2379
OWNER: CITY OF TIGARD, PHONE #: 503-639-4171
CONTRACTOR: RED HILLS ELECTRIC & TOWER SERVICES PHONE #: 503-554-8244
Inspection Request Scheduled For: Date: 6/27/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
Electrical final 010195.01 503-969-4054
Corrections/Comments/Instructions:
• •
•
Z PASS 0 PARTIAL APPROVAL CANCEL I I NO ACCESS
FAIL fl CALL FOR INSPECTION 111 ADDITIONAL FEES ASSESSED
ed
A A ir
Inspector: AT Date: " Phone #: (503) 718-