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Permit • CITY OF TIGARD ELECTRICAL PERMIT I PERMIT #: ELC2005 -00716 DEVELOPMENT SERVICES DATE ISSUED: 9/26/2005 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 - 4171 PARCEL: 2S1106C - 00900 SITE ADDRESS: 12475 SW BULL MOUNTAIN RD ZONING: R - SUBDIVISION: LOT : JURISDICTION: TIG Project Description: Installation of PVC for future power & controls. Job #87798. 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: 1 201 - 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: TIGARD WATER DEPT. OREGON ELECTRIC CONST /GROUP 8777 SW BURNHAM ST 1010 SE 11TH AVE TIGARD, OR 97223 PORTLAND, OR 97214 Phone: 639 -4171 395 Phone: 503 - 234 - 9900 FEES Reg #: LIC 203 Description Date Amount SUP 4460S ELE 26 -95C [ELPRMT] ELC Permit 9/26/2005 $62.50 [TAX] 8% State Surcharge 9/26/2005 $5.00 REQUIRED ITEMS AND REPORTS Total $67.50 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 - 332 -2344. Issued By: sJ :.6���i Permittee Signature: 52,,E 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. 74 ', SEP-23 -2005 11:05AM FROM -OR ELECTRIC SERVICE 5035352763 T -096 P.001 /002 F -375 ACCTr1Csl� reru><1i tiuuin auwu. I City of Tigard Recen-ed n .�0 ?- Permit Nu `��� f� ) 01/6 Deta I3� `7 v 13125 SW Hall Blvd, Tigard, OR 97223 - ;t Pla R vu w Other Perna Di Phone: 503.639.4171 Fax: 503,598.196 t►"a""/ iE, c ' 7.i7d�'. �� � a' n. ii!I SaePogo 2 ror Inspection Line: 503.639,4175 �� � li' l -. Date R<aJp . Intranet: www.ci_tigard.or.us Notieed/Method: T it; Supplemental C : C3 lJ TYPE OI? WORK PLAN REVIEW 2 New construction ❑ AddiiiM/ e l n5- nt Please check all that apply: ❑ Service over 225 amps, comml ❑Hazardouc ❑ Demolition ❑ 011 431111 DING DNISION ❑service over 320 amps— rating ❑Bnildng over 10.000 sq. ft., CATEGORY OF CONSTRUCTION . oft and 2 - family dwellings 4 or more new residential © I - and 2 family dwelling ® Commercial/industrial ❑ Accessory building ❑ system over 600 volts nominal units in one structure [I13uildin over three stories ['Feeders, 400 amps or more El Multi - family ❑ Master builder ❑ Other: ['Occupant load over 99 persona I0Manufactured structures or JOB SITE INFORMATION AND LOCATION ❑Egress/lighting plan RV park $"1-I 6 1 COYner O 'u11 I A111. 4 4 1315} [Wealth 2 - care eiity ❑other - Job n Job site address: Submit 2 sets of plans with any of the above. City /State/ZIP: The ■ SQYa t OR 10 St,J Pr ..--7 above are not applicable to temporary construction service. Suil'ebldg, /apt no.: Project name: - FEE SCRED1: Rterva1�'0Mp $ � n,u„a I Qtr. I lea I Total I -- Cross street/direction s to job site: New residential single or multi- family dwelling unit, Includes attached gantge. 1.000 sq. ft- or less 145.15 4 Subdivision: I Lot no.: - add'l 500 sq. ft or portion 33.40 — 1 Limited energy, residential 75.00 2 Tax map/parcel no.: Limited e nergy, non - residential 75.00 2 DESCRIPTION OF WORE- {(/1S`7LC- k'1'tm on \A sad] manuft6tUtedormodular r .. ` dwelling, service and/or feeder 90,90 2 11(15 - t 11oUl - iI U Ina U be 5� Q • Y services or feeders insttallrttion. alteration, and/or relocation ktvre oIni && 4. 0nr\ Tay t(le� PUMpti✓ 4 bJlkk1i 200 amps or less 8030 — 2 Y alb 201 amps to 400 amps 106.85 2 PROPERTY OWNER ❑ TEN T 401 amps to 600 amps 160.60 2 Name: ( i Ti 0 T 1 t 4 a ■i- 601 amps to 1,000 amps 240.60 2 Address: L 5 S W 4, '\'t. Over 1,000 amps or volts 454.65 2 4 Reconnect Only 66,85 2 City /State/Z[P: "Ti coo Q. q - a a3 Temporary services or feelers installation, alteration, and/or t i r relocation Phone: (61) 2 ) Ly / 3 — I.+ ( 1 J Fax ( ) 200 amps or less 66.85 1 Owner installation: This installation is being made on property that 1 own which is not 401 amps to 400 amps 100.30 2 intended for sale, lease, rent, or exchange. according, to ORS 447, 449. 670. and 701. 401 ,sups to 600 amps I33.75 2 Owner signature: Date: - Branch circuits —new, alteration, or extension, per panel ❑ APPLICANT I ❑ CONTACT PERSON A, Fee for branch circuits n'/Nh . _ - service or fader fce, each 6.65 2 Business name: branch circuit B. Fee for branch circuits Contact name: without service or feeder fee, 46.85 2 each brunch circuit Address: _ E ach add'1 b ranch circuit 6.65 2 City /State/ZIP: Miscellaneous (service or feeder not Included) pump or irrigation circle 53.40 2 Phone: ( ) I Fes ' ( Sign or otttlinc lighting 5140 2 E - mail: Signal circuit(s) or limited - CONTRACTOR energy panel, alteration, or extension, Describe: Page 2 2 Business name: Oregon Electric Group -- Address: 1010 SE 11th Ave Each additional inspection over allowable in any of the above . Per inspection i 62.50 (pa - 5C City /State/ZIP: Portland, OR 97214 Investigation per hour (1 hr min) 62.50 Phone: (503) 234 -9900 I Fax: (503) 535 Industrial plani per hour 73.75 ELECTRICAL PERMIT FEES* CCD Lie.: 203 Electrical Lie.: 1 S .'. . Lie.: 4460S subtotal (y q . 50 Suprv. Electrician signature, rcgaired: •' ' J 0 Plan review (25% of permit fee) IP Print Nlav K Date: l p 5 State surcharge (8% of permit fee) . 5. D O �' ,i TOTAL PERMIT FEE 1.09, 5v Authorized signature: , .0 This p application i t application expires Ira permit is not oblelard within 180 I days after it bas been accepted as complete Print name: Ma, _ Kt*, . e. ` 1 Date: 9.'N 3 l o 5 * Fee methodology set by Tri- County Building Industry Service 130a1/1 "Number of inspections per permit allowed QuesVons Si 14-ogioerg, Ore6ov- 6e.G-t is (50 Si -a103o CITY OF TIGARD - BUILDING DIVISION PERMIT #: ELC2Qi3 00716 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/26!2005 Phone: (503) 639 -4171 No r filll'� Inspection Requests (24 Hrs.): (503) 639 -4175 _.. INSPECTION WORKSHEET FOR DATE: 9/20/2005 TIME: 7:OQAM PAGE: 62 SITE ADDRESS: CLASS OF WORK: SUBDIVISION: 12475 SW BULL MOUNTAIN RD LOT #: TYPE OF USE: PROJECT NAME: CITY OF TIGARD • DESCRIPTION: Installation of PVC for future power & controls. Job #07799. OWNER: PHONE #: CONTRACTOR: TIGARD WATER DEPT.. PHONE #: 639 -4171 395 OREGON ELECTRIC CONST /GROUP 503- 234 -9900 Inspection Request Scheduled For: Date: 9/28/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 120 . ethics •'. -1-in 016836 -01 503 -849 -2652 Y Corrections/Co t ns /Co • en ons: ? 7.--,"" Ueb\)- \ A ry\ 2 ,Mivn NHS s A1J b ?� ` Fi(L P\I C c-4 N v'k1 Q\) 0 s_ .PASS I PARTIAL APPROVAL n CANCEL ❑ NO ACCESS I f FAIL CA FOR INSPECTION n ADDITIONAL FEES ASSESSED / Inspector: • Date: ` 2 # ---‘ Phone #: (503) 718- 27 /