Permit ELECTRICAL PERMIT
CITY OF TIGARD
PERMIT #: ELC2006-00433
DEVELOPMENT SERVICES DATE ISSUED: 8/4/2006
�' I 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 - 4171
PARCEL: 2S111 AA -04100
SITE ADDRESS: 14435 SW HALL BLVD ZONING: R -4.5
SUBDIVISION: GREENSWARD PARK LOT : 036 JURISDICTION: TIG
Project Description: Reconnect light pole. (SE corner of property, at Hall & Bonita).
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: 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:
FLOWERS, JAMES R TICE ELECTRIC
8935 SW EDGEWOOD ST PO BOX 15009
TIGARD, OR 97223 PORTLAND, OR 97293 -5009
Phone: Contact #: FAX 503- 872 -8290
PRI 503 - 233 -8801
FEES
Description Date Amount Reg #: ELE 26 - 126C
[ELPRMT] ELC Permit 8/4/2006 $46.85 L1C 156
[TAX] 8% State Surcharge 8/4/2006 $3.75 SUP 2586S
Total $50.60 REQUIRED ITEMS AND REPORTS
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All
work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended
for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set
forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at 503 - 246 -6699 or
1- 800 - 332 -2344.
Issued By: - '� �n' Permittee Signature: `y_„2 R, C)0 �3
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
ONLY
.. -. t — - - -FOR OFFICE U5 1 a Y.74
D p er mit 130,;
Ct?lOx1 ReG9ived -- � , u
Eleetri cal �' e� wit A Date/)3 : 14 Other Permit:
Plan Review See Page 2 for
City of Tigard /[,,1r,trj;nl *ro: ` \ Date/E1 S up p l e menta llnformatlon
Ball Blvd., Tigard, OR 972 t �' pate ILeadyl
13125 SW 4171 Fax: 503.598 ` 1 '�- NotificdlMctho
Phone: 503.639.
inspection Line: 503.639.4175
Internet: www.ct.tigard,Or.us Please check all that apply:
, OF WORK l []idsaardous location
❑Service over 225 amps, �T'g Buildng over 10,00D sq,„
0 N construction ®AdditionJalteratioll /replacement ❑Service over 320 amps - rant/ 4 or more new residential
Demolition of 1
[] Other: and 2-family dwellings units in one structure
C AT EGORY OF CONSTRUCTION ❑System over 600 volts nominal ❑Feeders. 400 stops oz mole
C [ Accessory building ❑$uilding over three stories
O 1- and 2- 'family dwelling ❑ O cces ❑Occupant load over 99 persons []lvlanufactured structures or
Master builder RV park
CI Multi-family plan 00ther:
JOB SSTE INFORMATION AND l C� -N ❑ljealth-cate
Submit 2 sets of plans with any of the above.
Job no.; 3. 3 8 8 8
Job site address: Hall Blvd @ Bonita Rd The abo
.
ve are not applicable to temporary construction service.
city/State/ZI Tigard, OR ��' �� FEE* sc$Envz � .
H all Blvd @ Qtr.
Suite/ bldg. /apt. no•: Project name: Bonita. c3 R New r single- or multi- [artily dwelling unit.
Cross street /directions to job site: Includes attached garage. 4
1,000 sq. ft. or less Mill 145,15
- 33.40 l
Ea. add') 500 sq. ft. or •onion 2
Lot no,: 75.00
Subdivision: — Limited energy, residential 2
Tax map /parcel no.:
Limited energy, non-residential 75.00
DESCRIPTION OF WORT{ Each manufactured or modular
'— dwellin. service and /or feeder 1111 90.90 F
r Services or feeders installation, alteration, .and /or relocation
�� - C I) ,,N,4-.... u 200 amps or less 80.30
5 6- - `S av,,/ 0 [ 201 amps to 400 amps 106 -E5 ,
❑ PROPERTY OWNER El TENANT
401 amps to 600 amps 160,60
•
Name: 601 amps to 1,000 amps 240.60
— _ Over 1,000 amps or volts 454,65
Address: Reconnect only 66.85
Ciry /State /Zip: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax; ( ) 200 am. s or less 66.85
Owner installation; This installation is being made on property that I own which is not 201 amps to 400 amps 100.30
intended for salt, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps _ 133.75
Owner Signature: Date; Branch circuits - new, alteration; or extension, per panel
❑ APPLICANT LI CONTACT PERSON A. Pee for branch circuits with
service or feeder fee, each 6.65
Business name: branch circuit
B. Fee for branch circuits
Contact name; without service or feeder fee, 1 46.85 4 6 . 8 5
Addre each branch circuit
Address: Each add'l branch circuit 6.65
City/State/ZIP: Miscellaneous (service or feeder not included)
Phone; ( ) Fax; ; ( ) Pump or irrigation circle 53.40
Sign or outline lighting 53.40
E -mail: Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or
extension. Describe: Page 2
Business name: Tice Electric Co,
Address: BO Box 15009 Each additional lns ■eetion over allowable in any of the about
Per inspection 62.50
City/State/ZIP: Portland OR 97293 -5009 Investigation per hour ( hrmin) 62.50
Phone: ( 503) 233-8801 1 Fax: (503 ) 872 -8290 - Industr'ialplantperhour 73,75
ELECTRICAL PERMIT FEES;
CCB L,ic.: 166 Electrical Lie.: 26 -126C Sup,r Lic•: 25865 Subtotal 4 6 . 8
Suprv. 7?lectrici signature, required: g et... _e t g � � 4 Plan review (25% ofpermit fee)
State surcharge (8% of p ermit f ee ) 3 • 7E
Print name: John J. Maloney Date: 8/4/06
TOTAL PERM F EE 50.6C
Authorized signature: This perm it application expires i,f a permit to not o b tained within 18
days after it has been accepted as com plete
Print name: Date: • Fee methodology set by Tri -County Bui]dins Industry Service Board
'• Number of inspections per permit allowed.
i:\9uildimg�emefts ,'r,C- permitAOp.doc 12/03 440 -46151-(10 /02 /COM/WEO
CITY OF TIGARD ..... ,_,4.- .
BUILDING DIVISION . t.
PERMIT #: ELC2006-00433
13125 SW Hall Blvd., Tigard, OR 97223
A DATE ISSUED: 8/4/2006
Phone: (503) 639-4171 ,,,,
Inspection Requests (24 Hrs.): (503) 639-4175 :zo 'i
INSPECTION WORKSHEET FOR DATE: 817/2006 TIME: 7:02Alvi PAGE: 61
SITE ADDRESS: 14435 SW HALL BLVD CLASS OF WORK:
SUBDIVISION: GREENSWARD PARK LOT #: 036 TYPE OF USE:
PROJECT NAME: LIGHT POLE IN R.O.W.
DESCRIPTION: Reconnect light pole. (SE corner of property, at Hall & Bonita).
OWNER: FLOWERS, JAMES R, . PHONE #:
CONTRACTOR: TICE ELECTRIC \\,.-, k III-N ) , PHONE #: 503-233-8801
Inspection Request Scheduled For: Date: 0/7/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
105 _ Underground/slab cover 034453-01 503-341-7328 Y
Cor -ctions/Comments/Instructions: CALL 2'
M1 g__.' Ok
\ EitiPIL.-
) C 0 oe LE 11 1910
...A.
!,,, ss fl PARTIAL APPROVAL n CANCEL n NO ACCESS
II — I I CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: )04756() Date: S -. 1 ° Ot Phone #: (503) 718:2
,,,