Permit q "t v CITY OF TIGARD ELECTRICAL PERMIT
y' h
° ' COMMUNITY DEVELOPMENT PERMIT #: E /16/20 -00708
DATE ISSUED: 10/16/2007
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S 110BA -03900
SITE ADDRESS: 14400 SW MCFARLAND BLVD ZONING: R -2
SUBDIVISION: SHADOW HILLS LOT : 026 JURISDICTION: TIG
PROJECT: POLSON -
Project Description: 2 branch circuits kitchen remodel.
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 HMI 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: 1 IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amplvolt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
POLSON, JAMES C AND ELIZABETH A ARLO ELECTRIC INC
14400 SW MCFARLAND BLVD 50705 NW CLAPSHAW HILL RD
TIGARD, OR 97224 FOREST GROVE, OR 97116
Phone: 503 - 624 -9164 Contact #: PRI 357 -2350
FAX 503 - 357 -9159
FEES
Description Date Amount Reg #: ELE 34 -1 18c
[ELPRMT] ELC Permit 10/16/2W $53.50 LIC 35763
[TAX] 8% State Surcharge 10/16/200' $4.28 SUP 3321S
Total $57.78 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 OW - at 503.246.6699 • r 1.800.332.2 4.
Issued By: Permittee Signature: /
. /
y L iifu 1///1.
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
C Received
of Tigard UE D / �� Permit No 7 7a
13125 SW Hall Blvd., Tigard, 9 Plan Review
I Phone: 503.639.4171 Fax: 503098.T961 6 / JI , / Date/By: Other Permt •
TI G A It D Inspection Line: 503.639.4175 • Date Ready/By: Juris. ® See Page 2 for
Internet: www.tigard -or.gov p�i ffIGARD Notified/Method: JJJ Supplemental Information
E' amoIVI,SIOr PLAN REVIEW
❑ New construction Addition/alteration /replacement 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 exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
d k- 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 ",
/ /�� 100HP or more. occupancy.
Job no.: Job site address:
/ p 6 , r �J �a V I a wd era. ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: --y^ /� ,, ❑ Health -care facilities. ❑ Supply voltage for more than
1�{/ G� / Z!/"( ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: U Project name: 5° i, ,d,a) ,L ``S ❑ Service or feeder 600 amps or more.
a, FEE SCHEDULE
Cross street/directions to job site: u a ftlie„ ,,,.) _ /tip Rd .6 Description Qty. I Fee. I Total I
t ` New residential single- or multi- family dwelling unit.
/PCTA (1 61444 .8 /1/1/ Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
t_Sk9G�UtI��`� Ea. add', 500 sq. ft. or portion 33.40 1
Tax map /parcel no.:
Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family 75.00 2
l. k_e-v1404t',1 residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
g PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2
Name: , —Y 04 4 _ F: 1 � a ( P is 401 amps to 600 amps 160.60 2
V �-�l 601 amps to 1,000 amps 240.60 2
Address: 5 a.4D G.Ci Over 1,000 amps or volts . 454.65 2
City/State /ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: (5 ) ( - q, 6.4 I 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
], APPLICANT I qi CONTACT PERSON above service or feeder fee,
each branch circuit 6.65 2
Business name: /Jv0.,0,1,L. /0 4 jam ..,i B. Fee for branch circuits
Contact name: D 2 u h I S D��de ( without service or feeder fee, 46.85 2
first branch circuit
Address: &go 6 6a) � 7 � 6 � Reco t � ((,� 4�,� � " sa � / tI Each add'1 branch circuit 1 6.65 2
/ T� 1 Miscellaneous (service or feeder not included)
City/State /ZIP: 2 Each manufactured or modular
T 1 Q G l ' S ?i�i. J 90.90 2
Phone: (Z3) 3 r) S F (6— C8 ) g6 o Reco service
only onl and/or feeder
I ax:: 66.85 2
E -mail: , Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Business name: !r _ Signal circuit(s) or limited -
/4 vw B/ D ' t ( energy panel, alteration, or
Address: extension. Describe: Page 2 2
City/State /ZIP: 0 Each additional inspection over allowable in any of the above
I Per inspection 62.50
✓
Phone: ( �j L I �Fax: ( ) I V Investigation per hour (I hr min) 62.50
�
CCB Lic.: / I Electrical Lic. , 1 -/i 6 G L I Suprv. Lic.: A A 1 6 Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal:
Plan review (25% of permit fee):
Print name: I Date: _
State surcharge -(8% of permit fee): S
Authorized sign • t e: _ TOTAL PERMIT FEE: 673-,-0, i ! This permit application expires if a permit is not obtained within 180
tint name: Date: LU -lCo�7 days after it has been accepted as complet AA ,,
W /"4/umber of inspections allowed per permit. Jv
I:\Building\Permits • PermitApp.doc 05/23/06 440 -46I5T 11/05/COB ei_
57.7g
Electrical Permit Application - City of Tigard
•
. ,,
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
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:
COMMERCIAL WORK ONLY:
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
I: \Building'Perrnits\ELC- PermitApp.doc 03/23/06
10/18/2007 10:31 5033579159 ARLOELECTRIC PAGE 01/01
CITY OF TI
' COMMUNITY DEVELOPMENT
'TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
• Electrical Signature Form
IMPORTANT PERMIT NOTICE
ARLO ELECTRIC INC
50705 NW CLAPSHAW HILL RD
FOREST GROVE, OR 97116
Permit #: ELC2007 - 00708
Date Issued: 10/16/2007
Parcel: 25 110BA -03900
Site Address: 14400 SW MCFARLAND BLVD
Subdivision: SHADOW HILLS
Lot: 026
Jurisdiction: TIG •
Zoning: R -2
Project Name: POLSON
Description: 2 branch circuits kitchen remodel;
Your company has been indicated as the electrical contractor for the permit referenced above. In order for the electrical
permit to be valid, the signature of the supervising electrician is required. Please have the appropriate individual from
your company sign below and return this Electrical Signature Form prior to the start of the work. Please mail the form to:
City of Tigard, Building Division, 13125 SW Hall Blvd., Tigard, OR 97223, or you may fax the form to: 503.624.3681.
If you have any questions please call 503.718.2433.
No electrical inspections will be authorized until this completed form is received
OWNER: ELECTRICAL CONTRACTOR:
POLSON, JAMS C AND ELIZABETH A ARLO ELECTRIC INC
14400 SW MCFARLAND BLVD 50705, NW CLAPSHAW HILL RD
TIGARD, OR 97224 FOREST GROVE, OR 97116
Phone #: 503 - 624 -9164 Phone #: . 357 -2350
Reg #: ELE 34 -118c
L1C 35763
SUP 3321S •
AN INK SIGNATURE IS REQUIRED ON THIS FORM
X 1 t, • - 6. Nein
Signature of Supervising Electrician -me (pr nted) SUP LIC #
CITY OF TIGARD .
BUILDING DIVISION PERMIT #: ELC2007••00708
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10116/2007
Phone: (503) 639 -4171 , 1'
Inspection Requests (24 Hrs.): (503) 639 -4175 �'!!+� °'I � ..
INSPECTION WORKSHEET FOR DATE: 12/4/2007 TIME: 7 :01AM PAGE: 20
SITE ADDRESS: 14400 SW MCFARLAND BLVD CLASS OF WORK:
SUBDIVISION: SHADOW HILLS LOT #: 026 TYPE OF USE:
PROJECT NAME: POLSON
DESCRIPTION: 2 branch circuits kitchen remodel.
OWNER: POLSON, ,JAMES C AND ELIZABETH A, PHONE #: 503624 -9164
CONTRACTOR: ARLO ELECTRIC INC PHONE #: 357 - 2350
Inspection Request Scheduled For: Date: 12/4 00 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 060747 -01 503.319-5878 Y Call Lo atir 5 y
Corrections/Comments/Instructions:
ei .-- ' '
•
•
X SS 11] PARTI ' L APPROVAL 111 CANCEL ❑ NO ACCESS
IL ❑ C i' F. - I ■ CT N ❑ ADDITIONAL FE S ASSESSED
Inspector: A `L/' Date: d Phone #: 503 7i
CITY OF TIGARD .
BUILDING DIVISION PERMIT #: ELC2007-00708
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/16/2007
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175
A ..
t !.L.
INSPECTION WORKSHEET FOR DATE: 10/19/2007 TIME: 7:01AM PAGE: 18
SITE ADDRESS: 14400 SW MCFARLAND BLVD CLASS OF WORK:
SUBDIVISION: SHADOW HILLS LOT #: 026 TYPE OF USE:
PROJECT NAME: POLSON
DESCRIPTION: 2 branch circuits kitchen remodel.
OWNER: POLSON, JAMES C AND ELIZABETH A, PHONE #: 603- 624 -9164
CONTRACTOR: ARLO ELECTRIC INC PHONE #: 357 -2350
Inspection Request Scheduled For: Date: 10/19/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
120 Electrical rough -in 057364 -01 503- 319-5878 V
Corrections /Comments /Instructions: �~ 7
PASS ❑ PARTIAL APPROVAL El CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: GY ' 1 `\ •v Date: 0119101 Phone #: (503) 718- Zy47