Permit C ITY OF TI V ARD ELECTRICAL PERMIT
r I PERMIT #: ELC2005 - 00572
i
DEVELOPMENT SERVICES DATE ISSUED: 8/10/2005
°T11 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S102DD -00200
SITE ADDRESS: 13500 SW HALL BLVD ZONING: R - 12
SUBDIVISION: EDGEWOOD LOT : 001 JURISDICTION: TIG
Project Description: Hall Blvd/Wall St. intersection. Signalization and driveway relocations.
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:
•
CITY OF TIGARD LIBRARY NORTHSTAR ELECTRICAL CONTRACTORS
13500 SW HALL BLVD. 19450 SWCIPOLE RD SUITE 107
TIGARD, OR 97223 TUALATIN, OR 97062
•
Phone: 503 - 639 -4171 Phone: 503 - 612 -0840
FEES Reg #: LIC 90454
ELE 34 -359C
Description Date Amount SUP 661S
[ELPRMT] ELC Permit 8/10/2005 $80.30
[TAX] 8% State Surcharge 8/10/2005 $6.42 REQUIRED ITEMS AND REPORTS
Total $86.72
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 o4Z 0 -33 344. eat, _ Q
Issued By: i at, 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 10SE ONLY .
RceeivcdZ/ / ectrical
X.ECEVIED , Date/By: . 404/P5-1 R E l ectrical
itINICL:EZAX05 '...' .2.—
Planning A4 prov 'Sign
City of Tigard
ft, Date/13y: ; • Permit No.:
1 3 125 SW Hall 131vd.
Plan RevieW Other
Tigard, Oregon 97223 AUG 0 9 2005 Date/By: i Permit No.:
Phone: 503 Fax: 503 ,.,\ Post
, Date/3y: ' Land Use
, Case No.:
Internet: www.ci,tigard.or.us CITY OF TIGAir 111 C on t act . i
e • . Juris.: El See Page 2 for
24 Inspection Request: 50M9 —' Name/Meti)od! J Supplemental Ina...made.. =.
1 .
.i ! ' rEArsIz:ItEVIEW '.1iiiiO'clitiac:i11 ■" ': ' '
' ew construction 0 Demolition • Scrvicelover 225 amps- • Health-care facility
commcrcisl . Q Hazardous. location
• Addifion/alteration/re.lacement II Other: 0 Servicclover 320 amps-rating of 0 Building over 10,000 square feet,
1;',.?MW4113,GORY.?,: e ICONS. TICTXON ':..1,fP .: . 1 & 2 family dwellings four or more residential units in
1 & 2 dwelling Commercial/Industrial 0 SYstemlover 600 volts nominal one structure
['Building over three stories fl Feeders, 400 amps or more
Acoesso Building 0 Multi-Family 0 Occupaiii load over 0 persons 0 Manufactured structures or RV park
Master Builder II Other: . 0 Egress/lighting plan 0 Other:
.. .; . :. - ;•k:t;-.•?.l i tal.O. t ! .S1 • ' :, AO t • , ; :4 ttEktl 10 , .!' 7 ' 5, 19!!^!;,,, , i ,/,',,i• i Subadt sets of plans with any of the above.
Th • :More are net dicable to tem. ora • construction service.
Job site address: 1-( f 4-. . p---ke- 1,3 60 0
Suite #: BldglA t,#: . , . Number of ins • ectlons .er . ern& allowid
Project Na Afrkl- A
me:H P./4 k_ ------
f Descrl Von Qty tree (ea.) Total 111
. - New reside tiai-single or multi-family per
Cress street/Dectioiito job site: dwelling unit. Includes attached garage.
,
• ,, 6. 7v .-- A t- 5/ 7--;:
,ei-,/ Service included: . •
1000 s . tl. lor less 145..15
c / t , V(A X(.1(97 Each additillnal 500 s . ft. or ..rtion thereof 3340 MI
. .4 — Limited en • 3, • residential IM 75-00
Subdivision: . L Ell
ot #: Limited en. k U , . non residential IM 75.00
Tax ma ./. arcci #: Each menu actured home or modular dwelling III
‘ „,- cri, ,Imram•35 1 = . ,, ,m - 0 0 4,t44 , 0 7:7.4 i ! ;• i i .. , 5 IF.,. service an • or feeder 90.90 II
I , a/L .,,<" / p 6,-, 5., ori r. readers - installation,
alteration c relocation:
ri
._././.... ..,,..
200 am.: o less 860 V
,-
I ir el ) 1 ' . 201 MD V" .. 400 am.S 106.85 PI
401 amps to 600 amps _ 1111 160.60 2
IEFIRTMIXEMESIKIE•aaril:M=Efaalii:11,8' .:: 601 am.. t 1 1000 am. . • lts • 240.60 2
Over 1000 :in.s or vo 454.65 Emu 2 I
Name: — ElallMIIIIIMMIMIMMIN 66.85
• I
—
Address: Tempora , services or feeders - instillation,
alteratloM or relocation:
Ci /State/Zi. : 200 am.s of less 66.85 111
• 201 am.; t 400 aro.s 11111. 100.30 gm
Phone: Fax: . . 401 to 600 sm.s NM 133- IN
' is Atit .' K "404' "IX': ;:. . 4,: i 2 .),00.1 1 Ph i a 3 . 7 '; 2:117 4 1 7 9 JP1i : .. Branch circuits - new, alteration, or
Name: • extension per panel:
A. Pee for trench circuits with purchase of
Address: service ;:r feeder fee each branch circuit 6,65
City/State./Zi B. Fee forl7ranch circuits without purchase of III 46.85 11111111
B. service Or feeder fee first branch circuit
Phone: Fax: . , Each additi.nal branch circuit IM 6 U
.
E-mail: tviise,(Sery ce or feeder not included):
7ErrriffR 0
,,, Each .urn .' or irri tr. ton circle I. 53.40 Mil
l',..;....;:1)::i, :01,111dE g ?.010.A!13E; ;:qt',f'.. . .- . .
E.,,,h sto cir outline lighting IM 53- M111.1111
Job No 7 . Signal circ4it(s) or a limited energy panel, MIIIIIMINIII
- alteration .( extension
Busin NorthStar Electrical Contractors Dtion:
19450 SW Cipolc Rd, #107 escrip EMI II
Addre Tualatin, OR 97062 — - Each add tlonal ins. ection over the allowable In an of the above:
Cit Lic (503) #34-359C CCB 490454 Metro #1911 612-0840 Fax (503) 612-0891
Per in- • et on . • hour min. 1 hour 6 Ell
rcurimmminenromma
Phone: I other: ; ■1 =MEM
CCB L-_..._...,. _ 0 ,. – ;.';;;;L% : i...
Supervising electrician . .. . Subtotal Eittejrp
si • ature re a WIT& - ...4 i Plan Review 25% of Permit Fee E.InINPJIIINIIII
!
Pr State Surchar, e 8% of Permit Fee EIIIVAV' F AMIIR
int Nam . /as . _ , g .... / t ilw ir44 Lie. #: _L" ,
. TOTAL PERMIT FE ' • 1131WEJAWAVAIII
Authorized Notice:I This permit application expires if a permit Is no e . tatted within
Signature: Date: , 180 da3ts after It. has been accepted as complete. •
*Fee m'ethodology set.by Tr Building Industry Service Board-
' • •
. (Please print name) , 110/' F ( t .
i:\Dsts \Permit FormskElePerroirApp.doc 01/03 / - 17 1 f
z0/u3 3Ed eIVISHIelON
T680ZT9EOZ SI:OT SOOZ/E0!8
CITY OF TIGARD ,4
BUILDING DIVISION PERMIT #: ELC2005 -00572
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/10/2005
Phone: (503) 639 -4171 0111
Inspection Requests (24 Hrs.): (503) 639 -4175 =2W
INSPECTION WORKSHEET FOR DATE: 11/16/2005 TIME: 7:03AIvi PAGE: 101
SITE ADDRESS: 13500 SW HALL BLVD CLASS OF WORK:
SUBDIVISION: EDGEWOOD LOT #: 001 TYPE OF USE:
PROJECT NAME: CCITTOF TIGi RD LIBRARY` -"
DESCRIPTION: Ft511 Fall bf. intersection. Signalization and driveway relocations.
OWNER: CITY OF TIGARD LIBRARY, PHONE #: 503-639-4171
CONTRACTOR: NORTHSTAR ELECTRICAL CONTRACTORS PHONE #: 503 - 612 -0840
Inspection Request Scheduled For: Date: 11/16/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
Electrical service 021338 -01 503. 612.0840 N
Corrections /Comments / Instructions:
•
M PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL I CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: / Date:/ ( Phone #: (503) 718 -