Permit CITYDF TIGARD ELECTRICAL PERMIT
° PERMIT #: ELC2008 -00504
COMMUNITY DEVELOPMENT DATE ISSUED: 9/3/2008
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 25101 BB -01000
SITE ADDRESS: 12110 SW HALL BLVD 1 ZONING: C -G
SUBDIVISION: TIGARD ROAD GARDENS LOT : 006 JURISDICTION: TIG
PROJECT: NI KZAD
Project Description: Reconnect only.
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: 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: 1 SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
ABBAS NIKZAD
13787 SW MARCIA DR
TIGARD, OR 97223
Phone: 503 - 544 - 1292 Contact #:
FEES
Description Date Amount Reg #:
[ELPRMT] ELC Permit 9/3/2008 $66.85
[TAX] 12% State Surchar 9/3/2008 $8.02
Total $74.87 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 •ay . • ain co••=s of these rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
Issued =.l �`� - + 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.
Electrical Permit „Application
FOR OFFICE USE ONLY
CEA R eceived � _ City of Tigard DateB : 9 Ir ll/_ Permit No.: V
INI
13125 SW Hall Blvd., Tigard, OR 9 f ? Plan Review
C Phone: 503.639.4171 Fax: 503.59:.1' • i q ZOa Date/By: Other Permit:
TI GARD Inspection Line: 503.639.4175 S-? U Date Ready/By: luri ® See Page 2 for
Internet: www.tigard or.gov ,\,�(°°��� Q1 pi�I Notified/Method I—G, Suppleme Information
TYPE OF WO No . stAt PLAN REVIEW
❑ New construction ❑ Addition /alter�it mt. * ` n� Ri Y9P P lease check all that apply (submit 2 sets of plans whtems checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition other: where the available fault current 0 Mannas and boatyards.
' CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
.Multi- family ❑ Master builder ❑ Other: ❑ Fire pump ❑ Installation of 75 KVA or
❑ Emergency system. larger separately derived system.
JOB; -SITE ,INFORMATION .AND LOCATION. ” 0 Addition of new motor load of ❑ "A ", "E ", °I -2 ", "1 -3 ",
Job no.: Job site address: 2 * - 110- <-fJ , di 17Li' 100HP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: 1 c Olk — 07 71 2 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: I f Project name: /' I�'4 ❑ Service or feeder 600 amps or more.
" t V , FEE SCHEDULE . . .
"
Cross street/directions to job site: Description I Qty. I Fee. 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 75.00 2
• . DESCRIPTION OF WORK , ' ' (with above sq. ft.)
Limited energy, multi - family
ACCPA/Nerh' 75.00 2
' /1� tr residential (with above sq. ft.) �d��` Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER, . • TENANT 201 amps to 400 amps 106.85 2
Name: / , �
q 401 amps to 600 amps 160.60 2
� � �' ` Z` , 4 r 601 amps to 1,000 amps 240.60 2
Address: 1-5 7 i- Q - w i1 D * Over 1,000 amps or volts 454.65 2
City/State /ZIP: 1 J d d � ' 6 L'Jl r1 / , Temporary services or feeders installation, alteration, and/or
/ relocation
Phone: ("Iie3) J5 if I " --I L .q Fax: (I/ ) 2 !��— T /L 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
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
A. Fee for branch circuits with
', ❑ APPLICANT I ❑ CONTACT PERSON N ' .. above service or feeder fee, •
each branch circuit 6.65 2
Business name: S c� f C' ( J, OV..( B. Fee for branch circuits
e(
Contact name: without service or feeder fee, 46.85 2
first branch circuit
Address: Each adds' branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City/State /ZIP: Each manufactured or modular
dwelling, service and /or feeder 90.90 2
Phone: ( ) Fax: : ( ) Reconnect only l 66.85 G� 2
E -mail: Pump or irrigation circle 53.40 2
, CONTRACTOR -. Sign or outline lighting 53.40 2
<�� Signal circuit(s) or limited -
Business name:
ly �� li/6 energy panel, alteration, or
Address: extension. Describe: Page 2 2
City/State /ZIP: Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: ( ) I Fax: ( ) Investigation per hour (I hr min) 62.50
CCB Lic.: Electrical Lie.: 1 Suprv. Lie.: Industrial plant per hour 73 75 _
ELECTRICAL PERMIT.. FEES
Suprv. Electrician signature, required: Subtotal: (4:9 s5
Print name: Date: Plan review (25% of permit fee):
- State surcharge (12% of permit fee): -3-.0„)._ Authorized signature: TOTAL PERMIT FEE: �/ / y� 7
Print name: // f ^ Date: A / This permit application expires if a permit is not obt within 180
�yv �l 7 ` ` days after it has been accepted as complete.
NO * Number of inspections allowed per permit.
I. \Building\Permits\ELC- PermitApp doc 05/23 /06 440- 4615T( I 1/05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
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:
EMMIS
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
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 \ Building \Permits\ELC- PermitApp.doc 03/23/06
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2008 -00504
13125 SW Hall Blvd., Tigard, OR 97223 - DATE ISSUED: 9/3/2008
Phone: (503) 639 -4171 o d il
Inspection Requests (24 Hrs.): (503) 639 -4175 ..' __.
INSPECTION WORKSHEET FOR DATE: 9/4/2008 TIME: 7:02AM PAGE: 12
SITE ADDRESS: 12110 SW HALL BLVD 1 CLASS OF WORK:
SUBDIVISION: TIGARD ROAD GARDENS LOT #: 006 TYPE OF USE:
PROJECT NAME: NIKZAO
DESCRIPTION: Reconnect only.
OWNER: NIKZAD, ABBAS PHONE #: 503 - 644 - 1292
CONTRACTOR: O f F + PHONE #:
Inspection Request Scheduled For: Date: 9/4/200f3 Pour Time: '
Code # Inspection Description Confirm # Contact # Message t
116 Electrical service 075074 -01 503. 544 - 92 N
Corrections /Comments /Instructions:
TPrt L 17 / =Ats7' »'1 L-- - 4F r o 11-7
,,,
, i9
[PASS ❑ PARTIAL APPROVAL n CANCEL [ I NO ACCESS
I J FAIL n CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: '3 N 06 L�,/ Date: Till Phone #: (503) 718 - Dig6
r' ( ( , "