Permit — "syC'TY OF TIGARD
ELECTRICAL PERMIT
PERMIT #: ELC2003 -00212
r
DEVELOPMENT SERVICES DATE ISSUED: 4/15/03
,f 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 1S135BB-00800
SITE ADDRESS: 10655 SW GREENBURG RD •
SUBDIVISION: ZONING: I -
BLOCK: LOT : JURISDICTION: TIG
Project Description: Install (1) branch circuit for security lighting.
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: SIGNAUPANEL:
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: 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:
FOURIER, GEORGE +JAN AND CHINOOK ELECTRIC CO.
LARSON, ALAN W TRUSTEE PO BOX 42016
349 W 71ST ST #1 EUGENE, OR 97404
NEW YORK, NY 10023
Phone: Phone: 541 - 461 - 2590
Reg #: ELE 20 -433C
LIC 138121
FEES SUP 4553S
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 4/15/03 $46.85
[TAX] 8% State Tax 4/15/03 $3.75 Rough -in
Elect'I Final
Total $50.60
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. (� i' ��,,
Issued By: ,75_, ,;,� �
4t Permit Signature: 9 112'lr'�"
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:��;►► [� / .c� Plt+�t DATE:
LICENSE NO:
Call 639 -4175 by 7:00pm for an inspection the next business day
• Ele c al Permit Received FOR OFF[Ele SSE ONLY
Date/By: y - 1 5 -D 2-, Be Permit No.2 OU P - DUa r 2
Cit of Tl alyd Planning Approval Sign
y g Date /By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: 503 -598 -1960 kaa Post - Review Land Use
�"
Internet: www.ci.tigard.or.us 101 I � Date /By: Case No.:
el Contact Juris.: ® See Page 2 for
24 -hour Inspection Request: 503- 639 - 4175 W Name /Method: Supplemental Information.
:, . 1. .. .. , ° :4 ° ° TI'PE QFeWORKt` =xa `: • ;r > a „. l all;,that ii14) ,.inT . ° , •
[11)_\IQW construction ❑ Demolition Service over 225 amps- ❑ Health -care facility
commercial ❑ Hazardous location
Addition/alteration/replacement ❑ Other: El Service over 320 amps- rating of ❑ Building over 10,000 square feet,
xis: P,w.r�,
•_„ , e , ;, _ MI ATEOORYTOC ONSTRUCTIQN; i. I & 2 family dwellings four or more residential units in
❑ 1 & 2- Family dwelling ❑ Commercial/Industrial ❑ System over 600 volts nominal one structure
❑ Building over three stories ❑ Feeders, 400 amps or more
❑ Accessory Building ❑ Multi- Family ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other:
.- Submit sets of plans with any of the above.
,�,. ,, „`,JOB SITEINEORMATION andrLOCAT$ION: �. t ..,-, The above are not applicable to temporary construction service.
Job site address: /0605 I (,t) C7rz di to ��. ,
l� S .. �-1 � � ° �- �.... - -E.� .�F`EES,CHE�D�'T,LE`�� .,._. ��� . � � _ .. r�:.�.:� '
Suite #: Bldg. /Apt. #: Number of inspections per permit allowed
Project Name: 4 , Description Qty Fee (ea.) Total
,1,-,IC 1,1 h . p
Cross street/Directions to job site: N ew 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 33.40 1
Limited energy, residential 75.00 2
Subdivision:
Lot #: Limited energy, non residential 75.00 2
Tax map /parcel #: Each manufactured home or modular dwelling
' •
�i --E a �, tiz ,, k service and/or feeder • 90.90 2
.
DESCRI`PTTONOFW
f _ ,ORK « Services or feeders - installation,
�I' ..Jf L. -' Ci t f .p L L� — C� tx-S f \ (/ !_Y / alteration or relocation: •
V 200 amps or less 80.30 2
201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
.a ` , s� _,� 60 1 amps amps 240.60 2 s to 1000 am
R ® :PROPERTY OWNER .. ; -. TENANT_. P P
Over 1000 amps or volts 454.65 2
Name: p [ Sc n (A 1A i 1--e_., Reconnect only 66.85 2
Address: Temporary services or feeders - installation,
alteration, or relocation:
City /State /Zip: 200 amps or less 66.85 1
Phone: Fax 201 amps to 400 amps 100.30 2
401 to 600 amps 133.75 2
• 1411 AWa ge �� COTACT�P
NERS A iF 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 T (_ U- 2
Phone: Fax: Each additional branch circuit 6.65 2
E -mail Misc.(Service or feeder not included):
y Each um or irrigation circle
, 53.40 2
f ;> g . . �CONT.R ACTOR ;-
pump g
<a. "�° Each sign or outline lighting 53.40 2
Job No: Signal circuit(s) or a limited energy panel,
Business Name: /J� / r \ alteration, or extension Page 2 2
l mil^ Ibtt� 0 k 6 C. �--CJ Description:
Address: 1 '00 0--K 1201(
Cit /State /Zi Each additional inspection over the allowable in any of the above:
y p: Eu� e,cti-Q_ .p)12 47 f'0 4 Per inspection per hour (min. 1 hour) 62.50
Phone: . 0- t 9 -o 3 4� g
Fax: Sf/ l 2 S a . Investigation fee:
p Z ( Lic. # , p -1 3 other
CCB Lic. #:
�• t � � ,, .tea >. 'girt, � Electrtcal ° PermitlFees t a �� ..w �
Supervising electric an / o --/ - 0 3 Subtotal $ We . 5.,6- signature required. 5 Z /] e kel Plan Review (25% of Permit Fee) $
Print Named/ Q(i/icfSet-rlrnu�► Lic. #: fi 5 S State Surcharge (8% of Permit Fee) $ 3.
/0 —/ _ TOTAL PERMIT FEE $ 50 , (00
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 Tri- County Building Industry Service Board.
' (Please print name)
I: \Dsts\Permit Forms \ElcPermitApp.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:
n Audio and Stereo Systems
IT Burglar Alarm
n Garage Door Opener
n Heating, Ventilation and Air Conditioning System
n Vacuum Systems
n Other
COMMERCIAL WORK ONLY:
Fee for each system $75.00
(SEE OAR 918 - 260 -260)
Check Type of Work Involved:
n Audio and Stereo Systems
n Boiler Controls
n Clock Systems
n Data Telecommunication Installation
F - 7 Fire Alarm Installation
n HVAC
F Instrumentation
n Intercom and Paging Systems
n Landscape Irrigation Control
n Medical
n Nurse Calls
n Outdoor Landscape Lighting
El Protective Signaling
El Other
•
Number of Systems
* No licenses are required. Licenses are required for all
other installations
i:\Dsts\Permit Forms\ElcPermitAppPg2.doc 01/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 •
BUP
i I
Received Date Requested 3 AM PM BUP
`Location / a ct, S s Suite MEC
Contact Person Ph ( ) PLM
Contractor -4 (`(l Ph ( ) Sq '6-1 2 S6SWR
BUILDING Tenant/Owner 5 (e3 ELC .3 -
Footing
ELC
Foundation
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: �}- (r SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm -
Susp'd Ceiling
Roof
Other:
Final .
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL •
MECHANICAL
Post.& Beam
Rough -In
Gas Line
Smoke Dampers
Final
T FAIL
• LECTRIC
Service
Rough -In
UG /Slab
Low Voltage
ir larm
PA PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk D a t e Insp or ® Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL