Permit i
CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2007 -00080
COMMUNITY DEVELOPMENT DATE ISSUED 2/5/2007
TIGARD 13125 SW Hall Blvd , Tigard, OR 97223 503 639 4171
PARCEL 2S101DA -01700
SITE ADDRESS 07130 SW FIR LP ZONING C -
SUBDIVISION 72ND BUSINESS CTR -VARNS PARK LOT 007 JURISDICTION TIG
Project Description. (4) branch circuits for lights & plugs in conf rm
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS 0 00 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 3 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
WHITE, FREDRICK A KAY A DICKENSON'S ELECTRIC
HELLMAN, DALE G 8449 SW BARBUR BLVD
PINELLI, MICHAEL J PORTLAND, OR 97219
CAVE CREEK, AZ 85331
Phone: Contact #. PRI 503- 246 -3550
FEES
Description Date Amount Reg # ELE 26 -140C
[ELPRMT] ELC Permit 2/5/2007 $66 80 LIC 65534
[TAX] 3% State Surcharge 2/5/2007 $5 34 SUP 31005
Total $72.14 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
more than 180 days ATTENTION Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center Th. e rule- --re set forth in
OAR 952- 001 -0010 through OAR 052- 001 -0100 You may obtain copies of these rules or direct questions to O�U � 9• -. ,.1- 0 332 2344
Issued By 2 , i Permittee 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
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
1
Electrical Permit ApPlicati �°' .i ,Fk., FI 1 •y C S O t NPA •f+v to 1 6F +t.:7
1 f _ � 1, a , ° ` y y I Fne )FFQC \ R(�I . i , r 1
✓ts ° h, I. City of Tigard b r — 5 2 00 7 Date/13 "7 d 7y �)` , Permit No e- 6
:� ^ 13125 SW Ball Blvd, Tigard, OR 97223 Plan Review -
+� Phone 503 639 4171 Fax 503 598 1960 Other Permit tiUF{BB Date/B
I nspection Lme 503 639 4175 o f ti ur i 1 a, Date Ready/By tuns la See Page 2 for
is K'[), g BUILDiW , Notified/Method. Supplemental Information
O U `is(�
1.41 �s Internet ww it dot 41
r =s. l'" TY F
PE; O
O' .'s. e 7'' y ', r • :. v'"<o ti4 "s 'tk Y,j. .'
, 65 t: 1 4 i'k ,3"
.,al
J
o New construction " Addit ion / alteration /replacement Please check all that apply (submit 2 sets of plans w /items checked below)
❑ Demolition ❑ Service or feeder 400 amps or more ❑ Building over three stones
❑ Other: where the available fault current ❑ Mannas and boatyards
,.'v : 4,€, .> `; �,I cru"ti -; ei, = CATEGORY OF CONSTRUCFION 1,t -17.. r P , - �'^ , ,' exceeds 10,000 amps a 150 volts or ❑ Floating buildings
- less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling • QCommercial /industrial ❑ Accessory building amps for all other nstallations buildings
❑ Multi- family ❑ Master builder ❑ Other. ❑ Fire pump ❑Installation of 75 KVA or
"• ' _• J S +INFORMATION AND LOCATION „a f• " -� �,. ❑ Emergency system larger separately den ved system
•• ., . .. ❑ Addition of mw motor load of ❑ "A ", "E ",'I 2 ", "I - 3',
lob no.: lob site address• —�-, / Ioo11P or more occupancy �/�7 r1Y'ff ❑Six or more residential amts ❑ Recreational vehicle parks
City /State/ZIP. 7 / 'j 7P ❑ Health -care facilities ❑ Supply voltage for more than
J ❑ Hazardous locations 600 volts nominal
Suite/bldg /apt no. Project name ❑ Service or feeder 600 amps or more
" :r (Z 1 t : R*. ' n - FEeSCBEDULE ` °'1: ^ >. ,, _3f�,9.,
Cross street/directions to job site onnW
cioa
I Q7 I Pm 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
3 •- ».+ '' `' C. ." DESCRIPTION OF W - ■ORK d "•_ _" "
" ' /' j; ;t: � m (with above sq ft) 75 00 2
J �/ / multi-family
Z is "ze_ L Y t
[. C_�'r ;!? Limited energy, multi-family -fa residential(with above fl) 75 00 2
v/ _ �• r Services or feeden installation, alteration, and /or relocation
200 amps or less 8030 2
¢,0;P1101'ERTY'OW96R_ ' ^ 2 I '+•' ❑.ITENANT''. - ['I u, 201 amps to 400 amps 106 85 2
Name: 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 fceden installation, alteration, and /or
relocation
Phone ( ) Fax. ( ) 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 599 amps 133 75 2
Branch circuits — new, alteration, or extension, per panel
Owner signature Date: A Fee for branch circuits with
• ' ", ❑ APPLICANT' ., ,
•'1; ` PO, CONTACT PERSON above service or feeder fee, 665 2
each branch circuit
Business name: B Fee for branch circuits
without service or feeder fee, / Q �
Contact name' first branch circuit ' 46 85 d� 2
Address' Each add' I branch circuit - .1 6 65 /9 ni ) 2
Miscellaneous (service or feeder not included)
City / State/ZIP. Each manufactured or modular 9090 2
Phone: ( ) Fax . ( ) dwelling, service and/or feeder
Reconnect only 66 85 2
E-mail. Pump or irrigation circle 5340 2
‘,•1;a: „ - "CONTRACTOR':' 1' 4 " - ,"" ' 1 - ",r. Sign or outline hghnng 5340 2
Business name :` - ! Signal circuit(s) or limited -
i) i /G�� ''� /;( e t , ' energy panel, alteration, or
6 Address 'q j 't( ] //;7 4 4..... /1 // /r` ." extension Describe Page 2 2
/y
City/ State/ZIP -- - /�a� G AZ rr� '7 ) J 3 Each additional inspection over allowable in any of the above
Phone e / Per Inspection 62 50
( SG' L � � � � -- 2..9 - � � Fax ( od Investigation per hour (1 hr nun) 62 50
CCB Lie •h „':3G7 Electrical Lie . -/y/e2 Supry Tic : 3/exv Industrial plant per hour 73 75
� 4, - r' ",- 1. “ELECTRICAL PERMIT FF,ES ii v "''
Supry Electrician signature. requ , - ''ire--'r--- Subtotal „� AY
Print name p 9 v , y / y t � t k - di , Date s -(« Plan review (25% of perms fee)
N/ t / / State surcharge (8% of permit fee) I V
Authorized signature: TOTAL PERMIT FEE 7 ,2 //
This permit application expires if a permit is not obtained within 180
Print name Date days after it has been accepted as complete.
• Number of inspections allowed per permit
i\BUddingtpesua PnmuApp doe 05/23/06 440.4615T(11/05 /COM/WlB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESLDENTIA WORK,ONLY:'�^' i ' 41
A.0 �1�9
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 : — � h y'" a - j
Fee for each commercial $75.00
system
(SEE OAR 918 -260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems
*No licenses are required. Licenses are required
for all other installations
I ‘amdin PUmuApp d« 03123,06
CITY OF TIGARD
BUILDING DIVISION . PERMIT #. EL C2007-00C30
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED 2/r
Phone (503) 639 - 4171 . 1
Inspection Requests (24 Hrs ) (503) 639 -4175 .!$. K'I��
INSPECTION WORKSHEET FOR DATE 9/27/2007 TIME 7:00AM PAGE A3
SITE ADDRESS 07130 SW FIR LP CLASS OF WORK -
SUBDIVISION 72ND BUSINESS C1R -YARNS PARK LOT # 007 TYPE OF USE
PROJECT NAME. SPEC SPACE
DESCRIPTION (4) branch clicurts for lights & plugs in cont. rm.
OWNER WHITE, FREDRICK A KAY A, PHONE #
CONTRACTOR DICKENSON'SELECTRIC PHONE # 503 - 2463550
Inspection Request Scheduled For Date 9/27/2007 Pour Time
Code # Inspection Description Confirm # Contact # Message
199 Electrical final Abe -01 503 -740 -0125 N
Corrections /Comments /Instructions. ' w
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PASS 0 PARTIAL APPROVAL I I CANCEL n NO ACCESS
CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector. G • teL OC6 I—. Date Phone #: (503) 718 - lak_____
CITY OF TIGARD . •
• _
BUILDING DIVISION PERMIT #: £IL2'i :fp
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 21; TIME: 7 W PAGE: .
•
SITE ADDRESS: (Y. yi Eli- If - CLASS OF WORK:
SUBDIVISION: ?:n.,.).E BusiNFt: ft: V,A PAP.V. LOT #: 00,7 TYPE OF USE:
PROJECT NAME: SPAC:r:
DESCRIPTION: branch !. •;07 h. )
OWNER: YT :MEDI•Zia, A KV PHONE #:
CONTRACTOR: L:qt;;KEN0t\II ELET,:1; PHONE #:
Inspection Request Scheduled For: Date: 2/6,?)0Q, Pour Time:
Code # InspeetiorrDescription Confirm # Contact # Message
Ge4303"i-O'i 5c.n 6 1- 2922
• f•-a-62.-1.-Adi..
Corrections/Comments/Instructions:
1ASS •
0 PARTIAL APPROVAL El CANCEL 0 NO ACCESS
El FAIL 0 CALL FOR INSPECTION LI ADDITIONAL FEES ASSESSED
Inspector: Date: ) Phone #: (503) 718-