Permit A CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2006 -00298
11. DEVELOPMENT SERVICES DATE ISSUED: 5/25/2006
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 1S134BD-07008
SITE ADDRESS: 11380 SW COTTONWOOD LN ZONING: R - 4.5
SUBDIVISION: ENGLEWOOD NO.3 LOT: 233 JURISDICTION: TIG
Project Description: Panel change.
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:
CHARLES COVINGTON DICKINSONS ELECTRIC
11380 SW COTTONWOOD LANE 8449 SW BARBUR BLVD
TIGARD, OR 97223 PORTLAND, OR 97217
Phone: Contact #: PRI 503 246 - 3550
FAX 503 - 213 -6049
FEES
Description Date Amount Reg #: ELE 26 -140C
[TAX] 8% State Surcharge 5/25/2006 $6.42 LIC 65534
[ELPRMT] ELC Permit 5/25/2006 $80.30 SUP 31005
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 suspended
for ore ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set
rth in OAR 952 - 001 - 0010 \hr \ 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.
ssued By: 0 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:
CONTRACT* '. ALLATION 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.
Ele ---f FOR OFFICE. USE ONLY- ct igal Permit Armlication
City of Tigard Date/By. - a 5 �.P G – f��29Q Received Ipq c Permit No.:
° I 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
. C ; • Phone: 503.639.4171 Fax: 503.598.1960 Date/By. Other Permit
T I G A R D Inspection Line: 503.639.4175 Date Ready/By: �Juris ® See Page 2 for
Internet: www.tigard - or.gov Notified/Method: / , Supplemental Information
• TYPE OF WORK PLAN REVIEW
❑ New construction Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition Other: where the available fault current ❑ Marinas and boatyards. •
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
)24- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
/ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
/
❑ Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION / ❑Addition of new mo tor load of ❑ "A ", `T ", "1 -2 ", "1 - ",
Job no.: Job site address: J 100HP or more. occupancy.
//� S� � ❑ Six or more residential units. 0 Recreational vehicle parks.
, City /State/ZIP: • ❑ Health -care facilities. ❑ Supply voltage for more than
/ ' G2 <
/ ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: I Project name: ❑ Service or feeder 600 amps or more.
V 1(7 i/
FEE SCHEDULE
Cross street/directions to job site: 7 Description I QtY. I Fee. I Total I •
New residential single- or multi - family dwelling unit.
•
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Tax map /parcel no.: • Ea. add'I 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
- DESCRIPTION 'OF WORK (with above sq. ft.)
•
fcrpt-2-8 ( Li misd energy, multi-famil 75.00 2
residential a
dential (with aboove e sq. q. ft.)
•
_ Services or feeders installation, alteration, and /or relocation
200 amps or less /' 80.30 }30,302
_ ❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps t' 106.85 2
Name: ° a �A G' z � r �� 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: ( Over 1,000 amps or volts 454.65 2
City / State/ZIP: Temporary services or feeders installation, alteration, and /or . '
relocation
Phone: ( ) I 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 599 amps 133.75 2
Owner signature: Date: Branch circuits – new, alteration, or extension, per panel
A. Fee for branch circuits with
❑ APPLICANT . I ❑ CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee, 46.85 2
first branch circuit
Address: Each add'I branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City /State /ZIP: Each manufactured or modular •
dwelling, service and/or feeder 90.90 2
Phone: ( ) Fax: : ( ) Reconnect only 66.85 2
E - mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Business name: J) Z/� �, t �� Signal circuit(s) or limited-
/ energy panel, alteration, or
Address: Ne e� �'w ✓4 6 ` .� ,„ extension. Describe: Page 2 2
City /State/ZIP: !f p o — Y '72-15' Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (5 b3) S
�� –0,2 ax' (s� of �� .3 (-� � y / , Investigation per hour (1 hr min) 62.50
S�
CCB Lie.: b'3 r Electrical Lic.: °` 'i"® a �(31'v. Lic.: . 9 / QDS - Industrial plant per hour 73.75
_ ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal:
Print name: Date: Plan review (25% of permit fee):
State surcharge (8% of permit fee): 6) / --
Authorized signature: _ TOTAL PERMIT FEE: f - 7' L
This permit application expires if a permit is not obtained within ISO
Print name: Date: days after it has been accepted as complete.
' Number of inspections allowed per permit.
I:\ Building \Permits \ELC- PermitApp.doc 05 /23/06 440- 4615T(I t/05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
;4�RESIDENTIAI: -WORK ONLY: _
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑
•
Burglar Alarm
❑ Garage Door Opener*
El Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(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*
El Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I: \Building\Pe mits\ELC- PermitApp.doc 03/23/06
CITY OF TIGARD ��n m m n��w m nn�m�»�nm�� .
BUILDING DIVISION ~~~~"~~~°""°~� ~�"°"~°"~~"~ PERM|T ELC2006-00398
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/25/2006
Phone: (503) 639-4171 Ai
Inspection Requests (24 Hrs.): (503) 639-4175 A- lil.
INSPECTION WORKSHEET FOR DATE: 5/2612000 TIME: 7:00AM PAGE: 40
SITE ADDRESS: 11380 SW COTTONWOOD LN CLASS OF WORK:
SUBDIVISION: ENGLEWOOD NO.3 LOT #: 233 TYPE OF USE:
PROJECT NAME: COVINGTON
DESCRIPTION: Panel change.
OWNER: COV|NSTOM.CM&RLEB PHONE #:
CONTRACTOR: 0CK!NSONSELECTR|C PHONE #: 503-24E-3560
Inspection Request Scheduled For: Date: 5126/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
030673-01 503-515'2922 N
1 c % P ..
Corrections/Comments/Instructions:
- \N.
c r ,
, �. __
�� ~
.
APASS CANCEL n NC�AC{�ESG
El PARTIAL
| | FAIL fl CALL FOR INSPECTION ADDITIONAL FEES ASSESSED
Inspector: Cr ^ Kbe t_- Date: 51 2—b C Phone #: (503) 718- {