Permit [TIP CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2008 -00157
COMMUNITY DEVELOPMENT DATE ISSUED: 3/20/2008
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1S135CA-02600
SITE ADDRESS: 11130 SW GREENBURG RD ZONING: R -12
SUBDIVISION: LOT : JURISDICTION: TIG
PROJECT: GOOD NEIGHBOR CENTER
Project Description: TI. Installing (4) branch circuits.
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: 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:
GOOD NEIGHBOR CENTER A & J ELECTRIC
11130 SW GREENBURG RD PO BOX 330
TIGARD, OR 97223 FOREST GROVE, OR 97116
Phone: 503 - 443 -6084 Contact #: PRI 503 - 359 -5891
FAX 503 - 359 -1981
FEES
Description Date Amount Reg #: ELE 34 -1C
c
II L,PRMTI ELC Permit 3/20/2008 $66.80 LI 59
'TAXI 12% State Surchar 3/20/2008 $8.02
SUP 4534S
Total $74.82 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 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: / imm ia Permittee Signature: ;GC
ii
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
k_
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.
-).
, - kiar 19 08 04:06p Leeann Greason 503-359-1981 p.2
.
- . ..
:- .
Eleetrkal Permit Applicati -FOR-OFFIcE ISE ONLY
.
, City of Tigard IIECEIV El .
Received
DatelBy: ffos c m11111111MMIES2.
il • 1312 5 SW Hall Blvd.. Tigard, OR 97223 En AR 1 92009 Plan Review
mit: . /
Al
Jr ''
1 1 •• •• Phone: 503.639.4171 Fax: 503.598.1960 !Vim D Othcr Per
ateiBv: ..,a .f._...
Inspection Line: 503.6394175 Date ReadyrBy: :UM' El See Page 2 for
TIGARD
Internet: v,,ww.tigard-ongov CITY OF TIGARD N1-id: Supplemental Information
„....i... ,, ;„,i.1;.: 1i,,?;. ipi... i',..' 0 It7 l' rviti i' - 1.:,;:i' -Pii: - i.iiii' ' il:.:4,. , -ri.-' 'ia:li 'is 'tom : ---:: ,,•-- "-.==.'"::
Please check all Mar apply submit 2 sets 00 71055 a'beies checked below):
0 New construetiOn - I C Additionialteration/rcplacement
0 Service or feeder 400 amps or more 0 Building over three stories
O Demolition 0 Other: . the Evallable fault current 0 Marinas and boatyards.
............................................................................................................................. 111 Dxceed 10000 amps at 150 volts or 0 Floating buildings
less to ground, or exceeds 14,000 0 Commercial-n:5c agnaillutal
O I- and 2-family dwelling MI Cortuncrcial/industrial 0 Accessory building amps for all other installations. buildings.
O Multi Q Master builder 0 Other: Fi re pump. 0 Installation of 7 5 KVA or
larger separately nerived system.
, ,
x ,,,, i: ..i i 12 1 0 Ad Etnergency system.
../il _litittifylK.A.M- Ml•47,:j-1 g.. :21:-.'7'4.,:lx•Le.rdition °Crew motor load of
1001-IP or more. occupancy
Job no.: lob site address: \ ...)) C
..9 "---A„. 0 Si x or more residential units. 0 Recreational vehicle park&
City/Slate/ZIP: ,/-
. L.• ' • - Jr-. '6 \ .. ID Healtli-carc facilities.
0 Hazardous lecations. 0 Simply voltage for more Mn
a
600 volts nominal.
Suitcibldg./apt. no.: .... Project name: •Ob /6,/"/1?, AP , 0 Service or feeder 600 amps or more.
A-- 4 . 1 i ' :*g., -- ss,gog( 1 : 1 1 ' . - t •::2. ,:t _,:-_-;
Cross strectid i rections to job silo: Description I Qty. I Fee. 1 Total I
New residential single- or multi-family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4 .
Subdivision: 1.01 no.:
Ea. addll 500 sq. II. or portion 33.40 I
Tax map/parcel no Limited energy, residential
75.00 2
i i7ii : 14 1 - ; 91P. S EIN I C:'''F i i - irli' ii iiEr:i7.4 : ?:iti 'qi. ' l i; i.:- i.vitl.. above sq 0.) ,
: . k Limited energy, multi-family
75.00 2
' \C‘, am \ residential (iNidiabo,e sq_ 0.)
' Services or feeders installation, alteration, and/or relocation
200 amps or loss 80.30 ' 2
, oicAiiii*vtigkaz:::iii 1 .1!,:,[1],;lititurriktit. v.4 , 4.,.,.: , 201 amps to 400 amps 106.85 - 2
Name: E/ / L
e_J77__. 401 amps to 600 amps 160.60 2
41)/10/ - 1 ,6 e
601 amps to 1.000 amps 240.60 2
Address: //(,. .3_,) .......„_( d,a,,061.4p_4 7, Over 1 000 amps or volts 454.65 2
CityiState/ZIP: f t C /9 b 02 9 7 g2.--3 Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 66.85 I
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
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
41 . i.;, : :,74: , ,,: . ::itzfoiotikip - b:awarg.:Jfit ' above service or feeder fcc,
6.65 2
each branch circuit
Business name: B. Fcc for branch circuits
Contact name:
withoot service or feeder fee, 1
46.85 qtb..s ,
, -
first branch circuit
Address: Each add'l branch circuit ,.......2,)
6.55 n,p5 2
Miscellaneous (service or feeder not included)
City:/Statc/ZIP: Each manufactured or modular
.90
dwelling, service and/or feeder
90 2
Phone: ( ) Fax: : ( ) Reconnect only 66.85 2
E-mail: Pump or irrigation circle 53.40 2
10 ill.' :1:, j':'2 11..4 :q151...A=4 Sign or outline lighting 53.40 2
Business name: A&J Electric
Signal circuit(s) or limited-
energy panel, alteration. or
Address: PO Box 330 extension. Describe: Page 2 l 2
City/StateiZIP: Forest Grove, OR 97116 Each additional inspection over allowable in any of the above
Phone: (503) 359 Fax: (503)359 Per inspection
Investigation per hour (i hr Oli 62.50
n) 62.50 i
(/CB Lie.: 959 Electrical Lic.: 34-1c Suprv. 1.ic.: 5055S industrial plant per hour
- E ii;ii,g0irititiqjlItaltitti .
' 'l,-7:i :Ii'F-i
Suprv. Electrician signature. required: Subtotal: C
Print name: Tony Wilson Date: Plan review (25% of permit fee):
Authorized signature: /. z ,.....„ ..iy
______ State surcharge ( I 2% of permit feel: 'g .
u
TOTAL PERMIT FEE:
Print name: Date: 'this permit application expires if a permit is not obtained within 180
days after it has been accepted as cum pletc_
' Number of inspections allowed per parmit.
1 .\13 t ildinsWermitsq:LC-Perini1App Sue C.5/23:06 440-46157(F Va5iCONLVE13
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2O08- 001f,7
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/...x.1
Phone: (503) 639 -4171 /,wdisu pj�l11
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 4/8/2008 TIME: 7:00AM PAGE: 8
SITE ADDRESS: 11130 SW GREENBURG RD CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: GOOD NEIGHBOR CENTER
DESCRIPTION: TI. Installing (4) branch circuits.
OWNER: GOOD NEIGHBOR CENTER, PHONE #: 603443.6084
CONTRACTOR: A & J ELECTRIC PHONE #: 503- 358- 'ra891
Inspection Request Scheduled For: Date: 4/8/2008 Pour Time:
Code # Inspection Description Confirm -,# Contact # Message
199 FIec :tri c:al final .)68051 -q1 971-645.3825 N
Corrections /Comments /Instructions:
N6fic Lo V® Ao>�' mM`t 15) T®
o kit LIZT z_stN (?UkTkc 1 3 11.16AM.
"W 6 e (kW .
PASS I I PARTIAL APPROVAL n CANCEL n NO ACCESS
I I FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: N&) W Date: 4 Phone #: (503) 718- 1 v
• -
CITY OF TIGARD
BUILDING DIVISION
PERMIT #: ELC2008-00157
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/20/2008
Phone: (503) 639-4171
19
Inspection Requests (24 Hrs.): (503) 639-4175 ,_4 4
INSPECTION WORKSHEET FOR DATE: 3/24/2008 TIME: 7:00AM PAGE: 37
SITE ADDRESS: 11130 SW GREENBURG RD CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: GOOD NEIGHBOR CENTER
DESCRIPTION: TI. Installing (4) branch circuits.
OWNER: GOOD NEIGHBOR CENTER, PHONE #: 603-443-6084
CONTRACTOR: A & J ELECTRIC PHONE #: 503
Inspection Request Scheduled For: Date: 3/24/2008 Pour Time:
Code # Inspection Description onfirm • Contact # Message
126 Wall cover 067167-02 503.686-5230
Corrections/Comments/Instructions:
PASS 0 PARTIAL APPROVAL fl CANCEL I I NO ACCESS
FA L n CALL FOR INSPECTION I I ADDITIONAL FEES ASSESSED
Inspector: ae L Date: 114 et Phone #: (503) 718-
_ . .
CITY OF TIGARD .-
BUILDING DIVISION ,. ,...
PERMIT #: ELC2008-00157
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/20/2008
Phone: (503) 639-4171
447,11Tv
Inspection Requests (24 Hrs.): (503) 639-4175 f'11-..
INSPECTION WORKSHEET FOR DATE: 3/24/2008 TIME: 7:00AM PAGE: 38
SITE ADDRESS: 11130 SW GREENBURG RD CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: GOOD NEIGHBOR CENTER
DESCRIPTION: TI. Inctalling (4) branch circuits..
OWNER: GOOD NEIGHBOR CENTER, PHONE #: 503 MO
CONTRACTOR: A & J ELECTRIC PHONE #: 50
Inspection Request Scheduled For: Date: 3/24/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
120 Electrical rough-in 06716-01 03-686-5230
• Corrections/Comments/Instructions:
(1 CO II CM% WEa V5VS ART At6. 30)
• P. S PARTIAL APPROVAL 0 CANCEL 0 NO ACCESS
. 16FA I fl CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: CD —s, Date: 124 0% Phone #: (503) 718- /AA
•