Permit CITY TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2005 -00151
DEVELOPMENT SERVICES DATE ISSUED: 3/14/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2 S 102 BA -01800
SITE ADDRESS: 09865 SW JOHNSON ST ZONING: R -4.5
SUBDIVISION: NO. TIGARDVILLE ADDITION AMEND LOT : 020 JURISDICTION: TIG
Project Description: 12 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: 11 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:
RYAN PADDOCK BRIDGEPORT ELECTRIC
4340 SE JOHNSON CREEK BLVD PO BOX 3037
MILWAUKIE, OR 97222 CLACKAMAS, OR 97015
Phone: 503 - 228 -0475 Phone: 503 - 969 -8646
FEES Reg #: ELE 3 -593C
UP 160048
Description Date Amount S 10
SUP 505595
[ELPRMT] ELC Permit 3/14/2005 $120.00
[TAX] 8% State Surcharge 3/14/2005 $9.60 REQUIRED ITEMS AND REPORTS
Total $129.60
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 Ce ter. Those
rules a r e set forth in r 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules • dir:, %t .�r sti ns O at
503 - 246 -6699 or 1 32 - 244.
Issued By: �� _�_ ` 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.
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Electrlcal lyermitA ,11 .tigii • • :,':.:,-- .' ,:: •-* , • • .FOR.OFFICEIJSE,ONIAr . - :'' 'i -. -.. , , •
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City of Tigard VI— Received 2
Date/By: ,:l / i /0 5 ......- 66 Permit No. : ,.....( 9 ..e.) / ... )51 . _ 0 0/5> -.
13125 SW Hall Blvd., Tigard, OR 97223 A io6 Plan Revie
Phone: 503.639.4171 Fax: 5O9960 ' L . m i ‘ 7 . 0 44010 Date/By: Other Permit:
InspectiomLine: 503.639.4175 ' alla. VI IP': "• Date Ready/By: Juris: . 0 See Page 2 for
.x.....s." - .....,/ -
Internet: www.ci.tigard.or.us GARD Notified/Method: / /C\ Supplemental Information
,tiv pf:1:), . 1
: ltaYoolaVrl fflrgtW:VWAaikipqmimrzwgnvrep,im ,104 ..,- .: . • .
-,4,6„,,,, M:ic:645' , . — ', : 4,4-,,-,-Am-,,,41,4:5„A.4 :,,.,i: ',1414;t5-A,^4 ,-;. . ;' 71 T,,4-.,
7New construction ' Addition/alteration/replacement Please check all that apply:
['Service over 225:amps, comm'l OHazardous location
0 Demolition Other:
IDService over 320 amps - rating EBuildng over 10,000 sq. ft.,
MOMPAMSWOrafittlirdie,AWKWIWalarRIA of I- and 2-family dwellings 4 or more new residential
- and 2-family dwelling El Commercial/industrial 0 Accessory building
6 Multi-family 1 74,
. 0 Master builder El Other: OSystem over 600 volts nominal units in one structure
OBuilding over three stories El Feeders, 400 amps or more
['Occupant load over 99 persons ['Manufactured structures or
VO`Pn itAPTAIMMIVV ID
ita-k AN„---s4„ , .„„ ,- • 4-7,, 1,-, Egress/lighting plan RV park
Job no.: Job site address: ig is c:, 5 5. w . aottivsnt-- EHealth-care facility. DOther:
Submit 2 sets of plans with any of the above.
City/State/ZIP7ri c C A 9'3-3 The above are not applicable-to temporary construction service.
Suite/bldg./apt. no.: Project name: tRicfSfrgKlgfnflgfkTMFW.7.'•,'":': .;' ' '
' Description Qty. Fee. Total **
Cross street/directions to job site: 9 ?(->....5 &ST 713 70i-fiki S3N.1 New residential single- or multi-family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea. add'! 500 sq. ft. or portion 33.40 - I
Limited energy, residential 75.00 2
Tax map/parcel no.: .
„ Limited ,rotaiV Vgi e V ted energy, non-residential 75.00 • 2
';' "V " ' , ' - '4Wriev e n i i tgl)- MireSTIiiOUIL ' A,av .
Each h f acture a or mo manufacture
- ,, dwelling, service and/or feeder 90.90 2
CUM-KS 06' iv" (131(3 f?t-t' AM " ff -i-1/43 oNie5 ' Services.or feeders installation, alteration, and/or relocation
I CrAole, 200 amps or less 80.30 2
:,W;VW'':'W, tatimmvoirostiks,vr..: etwonvurafigxweingtvom-42 201
amps to 400 amps 106.85 2
amps to 600 amps 160.60 2
Name: p p tv00 , 1c L
601 amps to 1,000 amps 240.60 2
. Address: Li 3 ' - t'- S. E. 3.-NC(L.eek CLQ-0 Over 1,000 amps or volts 454.65 2
Reconnect only : 66.85 * 2
City/State/ZIP: r Lt.,,,:l 0.... ic e .-e ofe- 93-a1 Z___ Temporary services or feeders installation, alteration, and/or
Phone: (503) zs - Fax: ( ) relocation
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 600 amps 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
wt. A . Fee for branch circuits with
4 'Al,:-W.4.:P :: .. -106.3mszw,„.. '..,,a' -,n.1,- 'e-,, service or feeder fee, each
6.65 2
Business name: branch circuit
B. Fee for branch circuits I ,
Contact name: without service or feeder fee, I
46.85 ZIV: - 2
each branch circuit
Address:
Each add'I branch circuit I I 6.65 - 9-3 ,: 2 -
City/State/ZIP: Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: ( ) Fax: : ( ) Sign or outline lighting 53.40 2
E Signal circuit(s) or limited-
anallAMMICUMOSsiATSOIWIII,Aniprat-intrit energy panel, alteration, or
extension. Describe: Page 2 2
Business name: 'Me 0 cAyn,r-r- £ L . ar c
Address: p. e),.0 3.a3-7 Each additional inspection over allowable in any of the above
Per inspection 62.50
City/State/ZIP: 0 (sic 13,4_m 5 Investigation per hour (1 hr min) 62.50
Phone: (5 el (a el' - i5C,, ( 6 Fax ( ) Industri plant per hour 73.75
-WalitaMIPMMEWPIER,71tr6Z
CCB Lie.: go csQ,(4 93 Electrical Lie.: 3 -5 y3 (.„ Suprv. Lie.: 505?...S Subtotal
...--
Suprv. Electrician signature, required Plan re
: ---e4s-f---/-
i .... „ —
_.-
view (25% of permit fee) .----
State surcharge (8% of permit fee) e i 2-
.„_..--
Print name: $ ,,, , : Date: 3// y/0 5 .,.,,
TOTAL PERMIT FEE I --
Authorized signature: 0 I / This permit application expires if a permit is not obtained within 180
/4 ' . days after it has been accepted as complete
Print name: 3 .e._ (2. ,
N . X Date: 3/ VAS * Fee methodology tel by Tri-County Building Industry Service Board
** Number of inspections per permit allowed.
i: \BuildingWermits\ELC-PermitApp.doc 12/03 440-461 5T ( 1 0/02/COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
raraWnINTOWirfnifanWangiVing
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*
n Other:
COME C'�Y�� YW a;; =- _'', ` °7
Fee for each commercial system $75.00
(SEE OAR 918 - 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
n Clock Systems
n Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
n Intercom, and Paging Systems
❑ Landscape Irrigation Control*
n 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 \Pennits\ELC- PemritApp.doc 04/03
{
CITY OF TIGARD
BUILDI D IVISION PERMIT #:
1 13x25 SW H G all Blv T OR 97223 DATE ISSUED: ELC2005- 00161
Phone: (503) 639 -4171 / �mar , Nni��p , l��i� l i' - 3/14/2005
Inspection Requests (24 Hrs.): (503) 639 -4175 ..... -_..
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
6/1/2005 7 :15AM 64
SITE ADDRESS: CLASS OF WORK:
SUBDIVISION: 09865 SW JOHNSON ST LOT #: TYPE OF USE:
PROJECT NAME: NO. TIGARDVILLE ADDITION AMEND 020
DESCRIPTION: PADDOCK
12 branch circuits
OWNER: PHONE #:
CONTRACTOR: PADDOCK, RYAN PHONE #: 503-228-0475
BRIDGEPORT ELECTRIC 503-96R-8646
Inspection Request Scheduled For: Date: Pour Time:
6/1/2005
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 008037 -01 603- 349 -1215 N
Corrections /Comments / Instructions:
,, ,6" /•-frfrj -, 9/ C'
A PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
n FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED.
i
6,"(mm,'
Inspector: Date: a Phone #: (503) 718-