Permit C ITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2006 -00034
DEVELOPMENT SERVICES DATE ISSUED: 1/17/2006
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S102AA -03802
SITE ADDRESS: 12445 SW ASH AVE ZONING: CBD
SUBDIVISION: TIGARD HIGHWAY TRACTS LOT : 023 JURISDICTION: TIG
Project Description: Replace 100 amp panel.
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:
MIKE CASEY HIGHLAND ELECTRIC COMPANY INC
2546 TALISMAN DR PO BOX 655
LAKE HAVASU CITY, AZ 86406 TROUTDALE, OR 97060
Phone: 503 - 431 -6972 Contact #: PRI 503 - 220 -1935
FAX 503- 674 -6717
FEES
Description Date Amount Reg #: LIC 109850
[ELPRMT] ELC Permit 1/12/2006 $80.30 SUP 2431S
[TAX] 8% State Surcharge 1/12/2006 $6.42 ELE 26 -962C
Total $86.72 REQUIRED ITEMS AND REPORTS
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
suspend :. or mo - ' an 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those
rules . re set forth in OA' 95 10 1!10 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions t OUNC at
503 ' 46 -6699 or 1 -800 -3 -2344
Iss ed By: ' f � 1 Permittee Signature: y
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: f` �'�' i' , : / r4 fZ DATE: //7410
LICENSE NO: / qv b
Call 503 - 6394175 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 0 � FOR of Flee USE O NLY
City of Tigard _ - EN Re ce i ved Permit No.:
Ti
13125 SW Hall Blvd., Tigar. 1 ;'''' „ Plan Review
Phone: 503.639.4171 Fax: S 0 VY- :.• ''i /44i ;r0ytiy 1''`� .Date/By Other Permit:
Inspection Line: 503.639.4175 ' �„ Date Ready/By: 3uris: ® See Page 2 for
Internet: www.oi.tigard.or.us l7 1'7 7.00 Nati fied/Method: Supplemental Information
TYPE OF WORLC� PLAN REVIEW
❑ New construction (Tv' '3 y r a di eal`I y �o ent Please check all that apply:
❑ Demolition v''4 G, 'f` � A -� OService over 225 amps, comm'l DHazardous location
1 ti, ❑ Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
'. ORY OF CONSTRUCTION of I - and 2 family dwellings 4 or more new residential
(g,1 and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑ Multi family ❑Master builder ❑Other: ❑Building over three stories ['Feeders, 400 amps or more
❑Occupant load over 99 persons ❑Manufactured structures or
. JOB SITE INFORMATION AND LOCATION ❑Egress/lighting plan RV park
Job no.: I Job site address: / 2 1 / 1 /5 — .3 l4...)6 v' ` . 4.19,_ ❑Health -care facility ['Other:
Submit 2 sets of plans with any of the above.
City /State/ZIP: 0%- The above are not applicable to temporary construction service.
Suite/bldg./apt. no.: Project name: FEE* SCHEDULE
Description I Qty. I Fee. I Total I **
Cross street/directions to job site: New residential single- or multi - family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: I Lot no.: Ea. add'I 500 sq. ft. or portion 33.40 I
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
Afieh"t4CP /( �/f'�"11 ^ dwelling, service and/or feeder 90.90 h(J 2
(� ( y • / Services or feeders installation, alteration, and /or relocation
200 amps or less ( 80.30 •,v 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85. 2
Ce % 401 amps to 600 amps 1 60.60 2
Name: 601 amps to 1,000 amps 240.60 2
Address: c ' ' •), le D� Over 1,000 amps or volts 454.65 2
/,� /� ry ! ! ,s/ / Reconnect only 66.85 2
City / State/ZIP: s' %2 14 L% lS &Tf/ (� Temporary services or feeders installation, alteration, and/or
y
Phone: ($ 2/3; 3/ —6 9 72 Fax: ( ) relocation
200 amps or less 66.85 1
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 . I ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each 6.65 2
•
Business name: branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee, 46.85 2
Address: first branch circuit
Each add'l branch circuit 6.65 2
City /State /ZIP: Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: ( ) I Fax:: ( )
Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited-
, , ONTO CTOR energy panel, alteration, or
s extension. Describe: Page 2 2
Business name: Ar i �'a� g
Address o Each additional inspection over allowable in any of the above
Per inspection 62.50
City /State/ZIP: /) 6' 0 A 04
_' O6 0 Investigation per hour (1 hr min) 62.50
. Phone: ( ) - 011 " /11 S Fax: ( ) % � 7 / �J Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES* ij
CCB Lic.: /t0 n J �' f 9Wc Q Electrical Li .: -.A 2( Suprv. Lic a _C. f 3 /s
Subtotal 61
Suprv. Electrician signature, required:, n Plan review (25% of permit fee) �1
Print name: G v . -Z-0- 1' 2.. Da : p // / State surcharge (8% of permit fee) 4. K ! .
/ Ipp TOTAL PERMIT FEE r 1 2-
,
Authorized signature: i This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: 6 P 4t. � j L � Date: /-- J 7'04 Fee methodology set by Tr p County Building Industry Service Board
v / /'� Number of inspections per permit allowed.
i:\ Bui lding\Permits\ELC- PermitApp.doc 12/03 440- 4615T(10 /02/COM/WEB
Electrical Permit Application - City of Tigard
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 918- 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*
❑ Medical
❑ 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 \Pertnits\ELC- PermitApp.doc 04/03
CITY OF TIGARD
BUILDING DIVISION
,„A„, • PERMIT #: ELC200600034
13125 SW Hall Blvd., Tigard, OR 97223 bATE ISSUED: 1/1712006
Phone: (503) 639-4171 1!
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 1/18/2006 TIME: 7:01AM PAGE: 84
SITE ADDRESS: 1244t SW ASH AVE CLASS OF WORK:
SUBDIVISION: TIGARD HIGHWAY TRACTS LOT #: 023 TYPE OF USE:
PROJECT NAME: CASEY
DESCRIPTION: Replace 100 amp panel.
OWNER: CASEY, MIKE PHONE #: 503
CONTRACTOR: HIGHLAND ELECTRIC k'OMPANY INC PHONE #: 503-220-1936
Inspection Request Scheduled For: Date: liti8/2006 Pour Time:
Code # Inspection Description onfirm # Contact # Message
199 Electrical final 0:4.1152-01 603-515-3140
•
Corrections/Comments/Instructions:
cjr s o . OF KNAIN
..
•
k DASS • n PARTIAL APPROVAL [1] CANCEL fl NO ACCESS
FAIL CALL FOR INSPECTION El ADDITIONAL FEES ASSESSED
Inspector: LI Date Phone #: (503) 718-