Permit C ITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2006 -00375
�� DEVELOPMENT SERVICES DATE ISSUED: 7/10/2006
A'�' 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S105DA -16400
SITE ADDRESS: 14565 SW KLIPSAN LN ZONING: R -7
SUBDIVISION: PACIFIC CREST LOT : 052 JURISDICTION: TIG
Project Description: 4 branch circuit
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: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
NICK WILSON PC ELECTRIC
14565 SW KLIPSAN LN. PO BOX 517
TIGARD, OR 97223 NEWBERG, OR 97132
Phone: 503 - 524 -6377 Contact #: FAX 503 - 538 -3965
PRI 503 - 538 -6033
FEES
Description Date Amount Reg #: ELE 36 -114C
[ELPRMT] ELC Permit 7/10/2006 $66.80 LIC 155180
[TAX] 8% State Surcharge 7/10/2006 $5.35 SUP 5012S
Total $72.15 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 Notificati n 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 UNC at 03 -24 699 or
1- 800 - 332 -2344.
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.
ElQeta al Permit Appli.—a • • FOR OFFICE.USE ONLY
.a,,,, . v
R E€e /- D �[p B� Permit N Cb 11 14 ' . 1 3125 SW Hall BlvdTigard, OR 97223 _ f //
' 12 • Phone: 503.639.4171 Fax: 503.598.1960 Date/By. Other Permit:
T I GA R D Notified/Method: Supplemental Information
Inspection Line: 503.639.4175 JUL 9fl U Date Ready/By: `, H See Page 2 for
Internet: www.tigard - or.gov ' II ' , T, � �1p _ PL AN REVIEW
Vf
❑ New construction ]d N( Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION . w. 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
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job no.: Job site address: 1466 s -i Six or or more. R occupancy.
S /�L� n.S�►J L!`� ❑ Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP: Q�-7 ❑ Health - care facilities. ❑ Supply voltage for more than
TiC+� / 7Z3 ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: / Lam, , .....07 A- ❑ Service or-feeder 600 amps or more.
FEE SCHEDULE "- .
Cross street/directions to job site: • j/ W r _ !'p ft, D escription I otr. I Fee. I Total I *
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: / -A.:4f Ft t_,, CA-z Lot no.: 52
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
." a , 'DESCRIPTION ,OF' WORK' (with above sq. ft.)
Limited energy, multi - family 75.00 2
/A/S72 r.-- A/El. 41"lJI r ft-4 a/ G //tt-vt ' ,- _ ' 'L.- residential (with above sq. ft.)
S� Services or feeders installation, alteration, and /or relocation
�. p V �+f - i- vl�'�1 200 amps or less 80.30 2
' ROPERTY OWNER - ' , ' • ❑,'TENANT . 201 amps to 400 amps 106.85 2
Name: �/ /�L Gel( L,56 amps to 600 amps 160.60 2
L,56 /k) 601 amps to 1,000 amps 240.60 2
Address: 145 S'L) eu Fs-N-0 L/V Over 1,000 amps or volts 454.65 2
City /State/ZIP: '7' 4 q 7 � 2? Temporary services or feeders installation, alteration, and /or
City/State/ZIP: / J relocation
Phone: (52 )3 ) - ..."24...-,./ 1 -7 Fax: ( ) 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
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
''" ' -' 0 APPLICANT 0 CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: Pe E ,Kiz,t C... B. Fee for branch circuits
Contact name: without service or feeder fee ' 46.85 , (1 2
ST7✓V� ¶'� P1"t�Ti(L first branch circuit
Address: P a , /3 d x 5' ( Each add'I branch circuit 6.65 9 9 2
Miscellaneous (service or feeder not included)
City/State /ZIP: E ach manufactured or modular
NT�(�.i� Ig__, `� - a s ► 7 90.90 2
dwelling, service and/or feeder
Phone: ( 9"1 /) 24C. — -7 U O O Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
, ` ' -
CONTRACTOR ' Sign or outline lighting 53.40 2
r Signal circuit(s) or limited -
Business name: pL. �t _Lt - ,2e� energy panel, alteration, or
Address: extension. Describe: Page 2 2
City/State/ZIP: N . Q A) 0
1 Each additional inspection over allowable in any of the above
0 1' Per inspection 62.50
Phone: ( ) Fax: ( h i C1 '� / 1 ' \ 0' Investigation per hour (1 hr min) 62.50
CCB Lie.: { y; ".' / 7 C1 Suprv. Lie.: 5J a.3 Industrial plant per hour 73.75
// 5 �V Electrical Lic.:� ,
. ELECTRICAL PERMIT. FEES <d ,, .
Suprv. Electrician signature, required: Subtotal: & ∎ � ■
. P_ lan- review-(25 %o£permit_fee): - - - -- -
Print name: / mate: State surcharge (8% of permit fee): 5' . 35
A Authorized signatt e TOTAL PERMIT FEE: 7�,li,
` / This permit application expires if a permit is not obtained within 180
/ x \ Print name. 4/ /e .41//t A.) Date: days after it has been accepted as complete.
• Number of inspections allowed per permit.
I:\ Building \Permits\ELC- PetmitApp.doc 05/23/06 440- 4615T(I I /05 /COM/WEB
.i
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY: r
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
OTIC /W,RCIAL WORK ONI I':� •: _ = .
Fee for each commercial $75.00
system
(SEE OAR 918- 260 -260)
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
1:\ Building \Pemits\ELC- PermitApp,doc 03/23/06
07/11/2006 08 :41 5032245239 ATLAS LANDSCAPE ARCH PAGE 01/01
07/10/2e06 1S'24 5932245239 ATLAS LANDSCAPE' ARCH
PAGE 02/02
CITY OF TIGARD 1 .
13125 S.W. HALL BLVD. D3 — 6V s _ 19 k e
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE °a4
• 0!:°
PC ELECTRIC , 1 PR
PO BOX 517 j o F� \G \ s \pN
NEWBERG, OR 97132 G \ 1 O
Electr cal Signature Form
Permit #: ELC2006 -00375 ' •
Date Issued: 1/1012006
Parcel: 2S 105DA -16400
Site Address: 14565 SW KLIPSAN LN
Subdivision; PACIFIC CREST
Block: Lot; 052
Jurisdiction: TIG
Zoning. R.7
Remarks: 4 branch circuit I
Your company has been indicated as the electrical crertractor for the perrnit indicated above. In Order for the electrical
permit to be valid, the signature of the supervising sl' ctrician is required. Please have the appropriate Individual from
your company sign below and return this Electrical Si gnature Form prior to the start of the work to the address above,
ATTN: Building Division.
No electrical inspections will be authorized unt 1 his completed form Is received •
I i '
OWNER: ELECTRICAL CONTRACTOR:
NICK WILSON PC ELECTRIC
•
14565 SW KLIPSAN L.N. PO BOX 517
TIGARD, OR 97223 NEWNBERG, OR 97132
Phone #•. 503- 5244377 Phone #: 503 -538 -8033 •
Reg #: ELE 36 -1140
LTC 153160
SIM .50115
AN INK SIGNATU lS REQUIRED ON THIS FORM
•
I /-�.. �f •
I .:17", re of Supervising Electrician
•
If you have any questions, please cell 503.718.24 i 3.
•
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I ' d 191798ESEDS D I H1D21J Zld Wt99O : L 900 I I I n.0
CITY OF TIGARD
.:. s.
BUILDING DIVISIOW PERMIT #: ELC2006-00375
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7110/2006
Phone: (503) 639-4171
• 401 i ii ,
Inspection Requests (24 Hrs.): (503) 639-4175 ,,,_61 - ,1 11—
INSPECTION WORKSHEET FOR DATE: 7/14/2006 TIME: 7: 16AM PAGE: 31
SITE ADDRESS: 14565 SW KLIPSAN LW CLASS OF WORK:
SUBDIVISION: PACIFIC CREST LOT #: 052 TYPE OF USE:
PROJECT NAME: WILSON
DESCRIPTION: 4 branch circuit
OWNER: WILSON, NICK
I PHONE #: 503-524-6377
CONTRACTOR: PC ELECTRIC PHONE #: 503-538-6033
Inspection Request Scheduled For: Date: 7/1412006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
150 Hot tub/spa/pool 033111-01 503-624-6377 Y 1 5 . e f:
Corrections/Comments/Instructions:
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N _PASS_ EI PARTIAL APPROVAL. Ei CANCEL NO ACCESS _ _
AIL I I CA FOR INSPECTION El ADDITIONAL FEES ASSESSED
2 Inspector: Date: - 7 if '1 0 Lo Phone #: (503) 718- A_____ 0
__ _ ,
CITY OF TIGARD
BUILDING DIVISION- PERMIT #: ELC2006-00375
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/10/2006
Phone: (503) 639 -4171 II
Inspection Requests (24 Hrs.): (503) 639 -4175 I!..
INSPECTION WORKSHEET FOR DATE: 7/13/20 TIME: 7:02AM PAGE: 43
SITE ADDRESS: 14565 SW KLIPSAN LN CLASS OF WORK:
SUBDIVISION: PACIFIC CREST LOT #: 052 TYPE OF USE:
PROJECT NAME: WILSON •
DESCRIPTION: 4 branch circuit
OWNER: WILSON, NICK PHONE #: 503 - 524.6377
CONTRACTOR: PC ELECTRIC PHONE #: 503 -5033
Inspection Request Scheduled For: Date: 7/13/2006 Pour Time:
Code # Inspection Description .. ' # - ontact : Message
150 Hot tub /spa/pool 033037 -01 503-524-6377 ' N
Corrections /Comments /Instructions:
i■ 0 AN S wit. _A7 ZoOk
tea
0)5u0 li P RO N G-
- -- -n -PASS _ )-PARTIAL- APPROVAL 0_CANCEL — XN_OACCESS
A FAIL X CALL FOR INSPECTION I I ADDITIONAL FEES ASSESSED
Inspector: G hR, , IV 6e Ls.' Date: 7 I 1' /' Phone #: (503) 718- 2
1