Permit ati CITY F ELECTRICAL PERMIT
' %_i -O" TIGARD PERMIT #• ELC2004 -00273
^ jEV SERVICES DATE ISSUED 5/19/2004
'° I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 - 4171
PARCEL: 2S103DC -00818
SITE ADDRESS 11230 SW FAIRHAVEN ST
SUBDIVISION: VIRGINIA ACRES NO 2 ZONING R - 5
BLOCK: LOT 011 JURISDICTION. TIG
Project Description: Repair meter base
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: 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. 1 SVC /FDR >= 225 AMPS. CLASS AREA/SPEC OCC:
Owner: Contractor:
GARY STALEY WILLAMETTE ELECTRIC INC
11200 SW FAIRHAVEN ST PO BOX 230547
TIGARD, OR 97223 TIGARD, OR 97281
Phone: 503 - 887 - 4002 Phone: 503 - 624 -3631
Reg #' LIC 75059
SUP 1965S
FEES ELF 34 -283(2
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 5/19/2004 $66 85
[TAX] 8% State Surcharge 5/19/2004 $5 35 Elect'l Service
Total $7220
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR Speaaally 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: /,_447/1„,......6--- Permit Signature:
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: S / $ - c 7
LICENSE NO: /`/ ( 5
Call 639 -4175 by 7.00pm for an inspection the next business day
Electrical Permit. Appikation FOR OFFICE USE ONLY
= lei Received / Electrical O ,r `el ttC II V CLi Date /By �Ji_. Penult No S& ay_ ,oO�7 �
City of Tigard Planning Approval Sign
b Date/By Permit No
13125 SW Hall Blvd MAY 19 2004 Plan Review Other
Tigard, Oregon 97223 p Date/Permit y Permit No
Phone 503- 639 -4171 Pakt a3F �' Post- Review Land Use
Internet www ci tigard 1 % Ag_DING UI v I ON arr 1f Date/By Case No
E Contact Ions El See Page 2 for
r
24 -hour Inspection Request 503- 639 -4175 Name/Method Supplemental Information.
4 " ,'f - = 'AN f sis • . „_ asp - n' '. F i t- A1V±tRE`U "move sercheck alpha "t,- 9 ).:r.S e
❑ New construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility
commercial ❑ Hazardous location
I. Addition/alteration/re e lacement ❑ Other: ❑ Service over 320 amps - rating of ❑ Building over 10,000 square feet,
i' t 6It .=.' TiEG,Sk 0 N$11RI3 , a -Tr r a„C • 7 I& 2 family dwellings four or more residential units in
[. 1 & 2- Family dwelling I ❑ Commercial/Industrial ❑ System over 600 volts nominal one structure
❑ Accessory Buildmg ❑ Multi-Family ❑ Building over three stones ❑ Feeders, 400 amps or more
❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
❑ Master Builder ❑ Other. ❑ Egress/lighting plan ❑ Other
is "e1 an[(iiiUVA1'ONn, *1 t `;2. Submit sets of plans with any of the above
The above are not applicable to temporary construction service.
Job site address 117.3u S ca Fa :. ' MC SA bn;A, , t: „EiEtseHEAt iSEtx'; 844 " i it
Suite #: I Bldg /Apt.# Number of inspections per permit allowed
Proiect Name f( ti ha Description Qty Fee (ea) Total i
Cross street/Directions to job site. New residential - single or multi- family per
dwelling unit Includes attached garage
Service included
1000 sq ft or less 145 15 4
Each additional 500 sq ft or portion thereof 33 4D 1
Subdivision: I Lot #: Limited energy, residential - 75 00 2
Limited energy, non residential 75 00 2
Tax map /parcel # Each manufactured home or modular dwelling
MT4 Aaear DESCRI$iA'ONgOI; @WOR&IZaniM' talAi service and/or feeder 90 90 2
Services or feeders - installation,
Rcpafr Me tee Laze - alteration or relocation•
200 amps or less 80 30 2
201 amps to 400 amps 106 85 2
401 amps to 600 amps 160 60 2
. 04�, P ROAnta]!la ' t+i R' n!* - j�` i � •i ', ,„ ( 601 amps to 1000 amps 240 60 2
Name 8 / Y S �
{ � Over 1000 amps or volts 454 65 _ 2
iV y Reconnect only 6685 (a i r�,�" 2
Address / / 2 o u s c.- f c, i 5 a. �-e. b j .... Temporary services or feeders - installation,
alteration, or relocation.
City /State /Zip: r, 5 i ,d_ t o /L 5 7 C t.3 200 amps or less 66 85 1
Phone: Pei - y V a c Fax 201 amps to 400 amps 100 30 2
`� y , UT.. y , ,, 'a8 f , . 40l to 600 amps 1 33 75 2_
',U® AP. —egle I;Ti�', '. , v El GOIN11AGD PERSC}N a Branch circuits - new, alteration, or
Name: extension per panel:
A Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 6 65 2
City/State/Zip: B Fee for branch circuits without purchase of
service or feeder fee, first branch circuit 46 85 2
Phone. Fax: Each additional branch circuit 6 65 2
E -mail Misc (Service or feeder not included)
at , % tat ,a e . vR ry ( x „ Each pump or irrigation circle 53 40 2
Job No • /179 7 Signal circun(s) or lighting 53 40 2
ahre
or energy panel,
Business Name: I,v. t l a ri e 4 a he o f' ._ .r. G alteration, or extension Paget 2
Description
Address 97/0 Sc., T; 5. a. c/ £I-
City/ State/Zip: G Each additional inspection over the allowable in any of the above:
`) p a- i V I / 7 2 t 3 Per inspection per hour (mm 1 hour) 62 50
Phone: 5fT- 6 iv - Ai/ Fax: 5 67y -253d Investigation fee
CCB Lic. #. U in r5 Lic # iv- en- - t• Other
Er - ., , - , aJatucaI`Fe"'Pmit{Feest ar $ `, ,
Supervising electrician Subtotal $ b 6 . 8d
st_ ature re aulred / Plan Review (25% of Permit Fee) $
Print Name pa- m -/e Lic # / S (, -c State Surcharge (8% of Permit Fee) $ S • 3 a
TOTAL PERMIT FEE 5 7 L ?...
Authorized Notice: This permit application expires if a permit is not obtained within
Signature Date 180 days after it has been accepted as complete.
*Fee methodology set by Tn- County Building Industry Service Board
(Please pnnt name)
i \Dsts\Femat Forms \E1cPemutApp doc 01/03
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all systems $75.00
Check Type of Work Involved
Audio and Stereo Systems
n Burglar Alarm
El Garage Door Opener
Heating, Ventilation and Air Conditioning System
Vacuum Systems
n Other
COMMERCIAL WORK ONLY:
Fee for each system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved•
E Audio and Stereo Systems
n Boiler Controls
n Clock Systems
n Data Telecommunmanon Installation
n Fire Alarm Installation
I-WAC
n Instrumentation
n Intercom and Paging Systems
Landscape Imganon Control
n Medical
Nurse Calls
E Outdoor Landscape Lighting
Protective Signaling
n Other
Number of Systems
* No licenses are required. Licenses are required for all
other installations
i \Dsts\Permit FormsWlcPemntAppPg2 doe 01/03
5/3/2005
Case Activity Listing 10 34 17AM
TIDEMARK Case #: ELC2004 -00273
COMPUTER SYSTEMS INC
"9 :Assigned, = Dorie r „Updated
( Activity" .Description= r Date d _ `Date 2 - I "Date4, " '1H'old' Disp " Tor wBy • ;` ..° By :Notes
ELCA001 Application received 5119/2004 None RECD JMT 5/19/2004
BLD
ELCA003 Permit created 5/19/2004 None DONE JMT 5/19/2004
BLD
ELCA730 Elect'! Service 5/24/2004 None PART DS 5/24/2004
JMT
ELCA500 (F) Issue permit ;/19/2004 None DONE JMT 5/19/2004
BLD
ELCA730 Elect'I Service 5/25/2004 None DONE DS 5/25/2004
HAP
ELCA800 Case Finaled 5/26/2004 None DONE JMT 5/26/2004
JMT
Page 1 of 1 CaseActivity rpt