Permit Efif • CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2008 -00076
COMMUNITY DEVELOPMENT DATE ISSUED: 2/12/2008
IGA' D 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1 S 135CA -02600
SITE ADDRESS: 11130 SW GREENBURG RD ZONING: R -12
SUBDIVISION: LOT : JURISDICTION: TIG
PROJECT: GOOD NEIGHBOR CENTER
Project Description: connect cooler /freezer walk -ins. Installing (5) 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: 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: 4 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:
INTERFAITH OUTREACH SERVICES, IN FRAHLER ELECTRIC CO
BY KIM BROWN 11860 SW GREENBURG RD
PO BOX 230821 TIGARD, OR 97223
TIGARD, OR 97281
Phone: Contact #: FAX 503 - 639 -4673
PRI 503 - 639 -4627
FEES
Description Date Amount Reg #: ELE 34 -13C
IELPRMTI ELC Permit 2/12/2008 $73.45 LIC 37410
'TAXI 12% State Surchar 2/12/2008 $8.81 SUP 1816S
Total $82.26 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 throu. OAR 952 - 001 -0100. Y.. .btain copies of these rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
, n
Issued By: _air r
•ermittee Signature: �Ca/A
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.
Electrical Permit Application- C r " r `
�a � _ 1 OFFICE l.1 ONLY -
City of Tigard r. - a V R Received
ty g .�z� Received i
Permit No.: ,
: , � �.. } 7
∎.I
�' - ° 13125 SW W Hall Blvd., Tigard OR 97223 Plan Review Other Permit:
y C Phone: 503.639.4171 Fax: 503.598.1.K03 1 1 2U08 Date /By:
T I G A R D' Inspection Line: 503.639.4175 I ..L. L Date Ready/By: luiis: H See Page 2 for
Internet: www.tigard or.gov r, Notified/Method: upplementalInformation
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❑ New construction DI A. e ,, tion -- i A I ' � 1 " Please check all that apply (submit a sets of plans w /items checked below):
❑ Demolition Other: ❑ Service or feeder 400 amps or more ❑ Building over three stories.
where the available fault current ❑ Marinas and boatyards.
�. ,, „,,, .:.,:' ..,•:::, :.:. _� ,._,,,�. „�,. .:. ., .'' 4;= exceeds 100 00 sat 150 volts or Floatm buildm
a.,: a; +. _ .CATE0* wOF<3CO *I:ii - C'LI SDP ❑ g &S
dwelling Commercial/industrial less to ground, or exceeds 14 ❑Co -use a
0
1 - and 2-family g [ ustlial ❑Accessory boil
am p s for all ocher installations. buildings.
❑ Multi- family 0 er builder 0 Other: ❑ Fire pump. ❑ Installation of 75 KVA or
>,.; ; , y �„ - _ CA ❑Emergency system. larger separately derived system.
r'- JOB=SITE IN:FORMON' AND LOTION
-• • -r - . A'TI .. - . ❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1-3 ",
Six or or more more R occupancy. Recreational Job no.: 65519 Job site address: 11130 SW GREENBURG • ROAD
❑ Six or more residential units. ❑Recreational vehicle parks.
City /State/ZIP: TIGARD, OR 97223 ❑ Health-care facilities, ❑ Supply voltage for more than
❑ Hazardous locations. volts nominal.
6 00 v
Suite/bldg. /apt no.: Project name: I V ❑ Service or feeder 600 amps or more.
GOOD NEIGHBOR CENTER _ _ __
�;�'a;�a;t "� • :_�.�` _ <F;EESC3_EDHITIE2,_ �z`i �;�a;I - ';'
Cross street/directions to job site: • Description , _ I Qty. I , F � . ,. ' T � l _ 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'l 500 sq. ft. or portion 33.40 1
• Limited energy, residential 2
. Vii f!- :. s. "f,, :i: _ �.4�. - . 1'•n �:r, =; �f� :r:.5� - ::,'L�, 7S.00
.•r,;:- . <x�,;,ga.a'. ._,�.:;:.:>,•:i_• >`; DE$ CR3PT�IONi= �UF= �WORK':i''s...,�';" �� i . 1 z,__;v'?`;:��� witha
- x.....:..._: •..•...,...,x.r`e,.• -_..< ...•...:�,,;:...,...:,..:a...,. �...,..•.:,. _ .....,•. • F_ �:v-: , . , - h.�= '• », l:,,; a sq.
Limited energy, multi - family 75.00 2
CONNECT COOLER /FREEZER WALK - INS residential (with above sq. di )
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
��.. WNERu �,a�: :�� `y:;' ® „ TENs1NT :�s'z�,r,,,:;,<•°�,.,... -;,
r _.... ;.,.,_- ,......�- w:,...���:•� . r... �,.. r_..�F`:4s� > "'�i`- '';.» .,. _.,..�..•....�: •<h,:r:E = „- �.- :.�,�:t 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/Z1P: Temporary services or feeders installation, alteration, and/or
- relocation --
' Phone: ( ) . - - • Fax: ( ) • - 200 amps or less - 66.85 1 -
Owner installation: This installation is being modS.on property that I on 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
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
., A. Fee for branch circuits with
r -,a ',,H �?41.;, , ., u':e.54.. v XA;S. :s < ty. - r�;�k� :r£-:.!. +.::k:i
:f ::,:;:. ® f,�iPETICAN1 . . :_. . s: -^ ., = ® TERSON = °;. -, >_,> sar.t above service or feeder fee,
,•,,. ,:�, r.::, • 665 2
Business name: each branch circuit
B. Fee for branch circuits
• Contact name: • without service or feeder fee, 1. 46 85 '46.85 2
first branch circuit
Address: Each add'1 branch circuit 4 6.65 ?6.60 , 2
Miscellaneous (service or feeder not included) '
•
City /State/ZIP: • Each manufactured or modular ' 9090 2
dwelling, service and/or feeder
Phone: ( ) Fax: : ( )
Reconnect only • 66.85 2
E -mail: Pump or irrigation circle 53.40 2
�- '.5'. - - Si or outline lighting 53.40 2 coil'
- CONT�RACTOR�' - m
Business name:' ,ER ELECTRIC COMPANY l Signal circuits) lt er ti or limited-
ener paae, aeraon or
• Address: - - -' - - '11860 SW - GREENBURG..ROAD . . • • `-` - - -• extension. D Page 2
City /Statel- 7.TP: - ` TIGARD, - 97223 - ' -- - '-- - - -- - -_ - _ -- • • • Each additional inspection over allowable in any of the above -
Per inspection - 62.50
Phon: (-50.3) - 6.39'= 4627- __ . .•. ' - Fax: ( - 503) ' • 639' - 46'73' • ' " Investigation perhour(1 hr min) ' ' . 62.50 .
CCB I is : `° ° 'Electrical L ic.: ` Su Lic:: • " •- -' • Industrial' plant per hour 73.75
_.. ply_
37410 34 -13C 1816S
, `5:. `? ',ELECTRICAL'1ERhiliTIF•EES: : `:,``', : =,; '
Silprv.. Electrician signature, required: `6_, �tf /��t ' (ID - Subtotal: 73.
Print name: R . W. � Date: 02/07/08 Plan review (25% of permit fee):
State surcharge (12% of permit fee): 8.81
Authorized signature: TOTAL PERMIT FEE: 82.26
Print name: Date: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Electrical Permit Application - City of Tigard
Page 2- Supplemental Information
LIMITED ENERGY PERMIT FEES:
';';':;ag.STP,PMM,W
Fee for all residential systems combined. .... ' . $75.00
_ .
Check Type of Work_Involved: , „ „
_ .Audio'and Stereo Systems* • _ •
O Burglar Alarm
• Garage Door Opener*
O Heating, Ventilation and Air Conditioning S
O Vacuum Systems*
O Other:
305:WORTAI-
Fee for each commercial $75.00
system
(SEE OAR 918-260-260)
Check Type of Work Involved: .
• 0 Audio and Stereo Systems
0 Boiler Controls
El Clock Systems
0 Data Telecommunication Installation
•
0 Fire Alarm Installation
HVAC • , .
Instrumentation . . ,
O Intercom and Paging Systems
O Landscape Irrigation Control*
El Medical
O Nurse Calls , _ _ .
El Outdoor Landscape Lighting* • ,
• El Protective Signaling
EJ Other _
Total number of commercial systems: •
*No licenses are required. Licenses are required
for all other installations
CITY OF TIGARD
BUILDING DIVISION _ _ _ ,
PERMIT #: ELC20013-00076
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2/12/2006
Phone: (503) 639-4171 ,_I VI 1 t
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 312112008 TIME: 7:03AM PAGE: 27
SITE ADDRESS: 11130 EM GREENBURG RD CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: GOOD NEIGHBOR CENTER
DESCRIPTION: connect cooler/freezer walk-ins. Installing (5) branch circuits
OWNER: INTERFAITH OUTREACH SERVICES, IN, PHONE #:
CONTRACTOR: MAHLER ELECTRIC CO PHONE #: 503-639.4627
Inspection Request Scheduled For: Date: 3/27/2008 Pour Time:
Cbde # Inspection Description Confirm-# Contact # Message
199 Electrical final 067420-01 N., 503-634627 N
. . --
Corrections/Comments/Instructions:
— ---
\
C)\,,
\ i\\
_,,.- •
(.. PAD 111 PARTIAL APPROVAL 0 CANCEL 0 NO ACCESS
FAIL fl CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED
Inspector:
e-. t46eLee
Date: ill at Phone #: (503) 718
,
_ _ _
CITY OF TIGARD
BUILDING DIVISION •
- PERMIT #: ELC2008-00076
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2/12/2008
Phone: (503) 639-4171 „.. Viti
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 3/2.4/2008 TIME: 7:00AM PAGE: 25
SITE ADDRESS: 11130 SW GREENBURG RD CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: GOOD NEIGHBOR CENTER
DESCRIPTION: connect cooler/freezer walk-ins. Installing (5) branch circuits
OWNER: INTERFAITH OUTREACH SERVICES, IN, PHONE #:
CONTRACTOR: FRAMER ELECTRIC CO PHONE #: 503639-4627
Inspection Request Scheduled For: Date: 3/24/2008 Pour Time:
Code # Inspection Description Confirrn Contact # Message
199 Electrical final 167201-01 503-639-4627
Corrections/Comments/Instructions: 0
XS " O 6 g. G 6 1661 F*4(t. caiL
S * wkue....1 A FRA*-2.,123,
I PASS El PARTIAL APPROVAL fl CANCEL n NO ACCESS
FAIL CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
N'US
Inspector: Date: 1' Cet Phone #: (503) 718- 21/1A