Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2007 -00398
COMMUNITY DEVELOPMENT DATE ISSUED: 6/12/2007
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S 103DC -01000
SITE ADDRESS: 11265 SW GAARDE ST ZONING: R -3.5
SUBDIVISION: LOT : JURISDICTION: TIG
PROJECT: TIGARD ASSEMBLY OF GOD
Project Description: Electrical service for modular building.
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:
TIGARD ASSEMBLY OF GOD PRECISION NW ELECTRICAL
11385 SW FAIRHAVEN ST 12020 SE ANNA CT
TIGARD, OR 97223 DAMASCUS, OR 97009
Phone: Contact #: PRI 503 413 - 9870
FAX 503- 521 -1637
FEES
Description Date Amount Reg #: ELE C47
[ELPRMT] ELC Permit 6/12/2007 $80.30 LIC 163318
[TAX] 8% State Surcharge 6/12/2007 $6.43 SUP 50365
Total $86.73 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.
Those rule re set rth in OAR 952 - 001 -0010 through OAR 952 -001 -0100. You may obtain copi-. • hese rules or direct questions to OUNC at
503.246 699 or 1.800 .
Issued By: v iv 47kt , ci i Permittee Signature: r 1 J (
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.
Jun 11 07 09:40p Mike P McDonald 503- 521 -1637 p.2
Elect4itkal 1Perm A pplica t t, -
V cif! I F 1C'E USE: ONLY .
City of Tigard '' ED FOR O
Received
SW Hall Blvd., Tigard, OR 3 Dates . 4 Re 7 '' Penn Ems, /0 003578
Phone: 503.639.4171 Fax 503598.1 . 2, 200 Pico Review
503.639.4175 r! A f Dat R Other Permit: Line: 5 Ti'' " ' • ' i DmeReady
Internet wwW.ci ¢ - ® g Page2
gazd.cr.us CITY O ' '' 1 Notifted,Mdbod: an Su pp)�ag tat Inffor o rm a t i on
WORK . PLAN REVIEW
❑ New construction 0 Addition /alteration/replacetnent Please check all that apply:
❑ Demolition ❑ Service over 225 amps, comrn'I ❑Hazardous location
❑Service over 320 amps - rating i❑Buildng over 10,000 sq. ft,
. CATEGORY- OF CONSTRUCTION of I- and 2- family dwellings 4 or more new residential
Q 1 and 2 family dwelling CcxmRercial/indusfritd 0 Accessory building ❑System over 600 volts nominal units in one structure
❑Building over three stories 0 Feede s, 400 amps or more
❑ Multi family ❑ Master builder - ❑ Other:
JOB SITE INFORMATION AND LOCATION ❑Ocxupant load ova 99 persons ❑Manufactured structures or
0Egress/ligb8 plan RV park
Job no.: 1 lob site address: I r2- (i7 Y 0 L • ❑Health -care facility °Other: i
Submit 2 sets ofplans with any of the above.
City /State/ZIP: -- . 0 ,e_ q 727;3 The above are not applicable to temporary construction service.
Suite/bldg./apt no.: Project name: ,, ' 3 C.4,- 5. FEE* SCHEDULE
nesertaika l Qtr'- I Fm ] Total I • •
Cross street/directions to job site: -+tX.) 1 New residentielsirgle- ormulti- family dwelling unit.
� a 1/4...1/4) In attached garage.
l 1,000 sq. It or less 145.15 4
Subdivision: I Lot no.: En. add, 500 sq. ft or portion 33.40 1
Tax .map/parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK" . Each manufactured or modular
WO n # / dwelling. service and/or feed= 90.90 2
' ,,�, l� Q \ ' - Q ' �'�� �� '"" Services or feeders Installation, alteration, and/or relocation
�C� P."/ n� p /vim 200 amps or less ,.. 80.30 L' �.. 2
I
❑ PROPERTY OWNER . `� ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 ' 2
Name: _
601 Address: Ova l 0000 tum 2
or volts 454.65
2
Reconnect only 66.85 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
Phone: ( ) Fax: ( ) relocation
200 amps or less 66.85 t
Dwner installation: This installation is being made on property that l own which is not 201 amps to400 amps 10030 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to tiro am -
autos 133.75 _ 2
Dwner 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
3usiness name: branch circuit 6.65 2
B. Fee for branch circuits
outset name: without service or feeder fee,
address:
cacti branch circuit 46.85 2
Each add'1 branch circuit 6.65 2
:ity /State/ZIP: Miscellaneous (service or feeder not included)
'hone: ( ) Fax:: ( ) Ptrtnp or irrigation circle 53A0 2
Sign or outline lighting 53.40 2
Tread : Signal circuit(s) or limited-
CONTRACTOR energy panel, alteration, or
extelsion.Deswibc • Page 2 2
usiness name: -<j,4 4 /1, 'LTV.) ' C
Wdress: , �� 5e �. f - Each additional inspection over allowable in any of the above
Per inspection 62,S0
ity /State./ZIP: D ��'
Y4'kg i,.. L.) `S ; i , GA_ et--p -0 C) Investigation per hour (1 t r min) 62.50
'hone: (6 413 -4 b i- o ! Fax: (S0 6'2A —10-'5-3— Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES'
'CSLimo.:'b33‘46 i Electrical Li c.: <4.J 1 Suprv Lic..:503 t0 S Subtotal r
:wry. Electrician signature, required: \ t Plan review (25% of permit fee) . '
'riot name:I \(C I? 1 per' (01.-4 l ._� Slate surcharge (8%ofpnit fee) �+ vi � w ch permit
PERIVIIfl' FEE ` 1 -
1.uthori Zed signature: ��A n R T permi application expires if a permit is not obtained r in 180
+' v �/v days afterit bar been accepted es complete
lint name: Date: • Fee nxlbodology set by Td- Coimly Building industry ServixBeard
•• Ntunkerof inspections per permit allowed.
to Wing \Pamits\ELC- PcnndApp.doc 12/03 440- 4615T11C/02JCOM(WEB
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2007 -00390
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 6/12/2007
Phone: (503) 639 -4171 t«" iii
Inspection Requests (24 Hrs.): (503) 639 -4175 - IA- LL
INSPECTION WORKSHEET FOR DATE: 6/19/2007 TIME: 7:01AM PAGE: 66
SITE ADDRESS: 11265 SW GAARDE ST CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: TIGARD ASSEMBLY OF GOD
DESCRIPTION: Electrical service for modular building.
OWNER: TIGARD ASSEMBLY OF GOD, PHONE #:
CONTRACTOR: PRECISION NW ELECTRICAL PHONE #: 503 - 413 -9870
Inspection Request Scheduled For: Date: 6/19/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message .
115 Electrical service ' 050458 -01 503- 413.9870 Y
Corrections /Comments /Instructions:
PASS (l PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
I i FAIL CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: i�/ Date: - Phone #: (503) 718 -
•