Permit `' CITY OF TIGARD ELECTRICAL PERMIT
R PERMIT #: ELC2002 -00060
-04, DEVELOPMENT SERVICES . DATE ISSUED: 2/15/02
13125 SW Hall Blvd., Tigard. OR 97223 (503) 639 -4171 PARCEL: 1S136AD -04000
SITE ADDRESS: 11507 SW PACIFIC HWY B
SUBDIVISION: VILLA RIDGE ZONING: C -G
BLOCK: LOT : 007 JURISDICTION: TIG
Project Description: Installation of (2) branch circuits for new roof top a/c unit. Job No. 1 -3121
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: 1 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:
SMITH, EDITA M DYNALECTRIC
833 NW 170TH DR 2904 SW FIRST AVE.
BEAVERTON, OR 97006 • PORTLAND, OR 97201
•
Phone: • Phone: 503 - 226 -6771
Reg #: LIC 066793
SUP 2950S
ELE 26 -59C
FEES Required Inspections
Type By Date Amount Receipt Rough -in
PRMT CTR 2/15/02 $53.50 2720020000( Elect'I Final
5PCT CTR 2/15/02 $4.28 2720020000( EXPIRED
Total $57.78
This Permit is issued subject to the regulations contained in the Tigard Munidpal 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 - adopted by the Oregon Utility Notification
Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0080. : may obtai opies of these rules or direct questions to
1 /
Permit Signature: [/ Iss ed By: / , /
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 IN TALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: A /( i4L DATE:
LICENSE NO: -S
Call 639 -4175 by 7:00pm for an inspection the next business day
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Electrical Permit Application
Datereceived: Permit no.: � . _.1–ed AO
�.:;� . .
, - ,j '; E ; �:I ' (" C of Tigard Project/appl.no.: Expire date:
•
City of Tigard Address: 13125 SW Flail Blvd, Tigard, OR 97223 Date issued: By: Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: _ -- - --
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory O ❑ Multi - family ❑ Tenant improVement
❑ New construction ❑ Addition/alteration /replacement 0 Other. ❑ Partial
JOB SITE INFORMATION
Job address: //5 '. -, p _ . w Bldg. no.: Suite no.: $ Tax map /tax lot/account no.:
Lot: Block: I Subdivision:
Project name: • I Description and location of work on premises: LI '11° !2 ooF 4C .4 PLvt�.
Estimated date of completion/inspection:
CONTRACTOR APPLICATION FEE SCIIEDU.E
Job no: _ -ty fa Fee Max
Business name: J 1/).14 `l�'_ Description Qty. (ea) Total no. Insp
New residential - single ornmbi- family per
Address: r
5►. � ST 1 .., d welling mtit- Includes attached garage.
City: ' I State?? I ZIP: 9-2 dot Serviceincluded:
Phone: - , — _ -7 Fax: • ., 77 0 E -mail: 1000 sq. ft. or less 4
••0 Each additional 500 sq. ft. or portion thereof
Elec. bus. lic. no:
CCB no.: /��7 - -
Limited energy, residential 2
City/metro lic.no.: 62 A ' 7 -3205 Limited energy, non- residential 2
Signature of supervis�jl
4. 2// 1JZ Each manufactured home or modular dwelling
�' 6,-,.. g el trmcian (required) Date 3 Service and/or feeder 2
Sup. elect. name (print): rn1 License no: , • S Services or feeders –installation,
alteration or relocation:
PROPERTY OWNER 200 amps or less 2
Name (print): 201 amps to 400 amps 2
401 amps to 600 amps 2
Mailing address: • 601 amps to 1000 amps 2
City: 'State: I ZIP: Over 1000 amps or volts 2
Phone: J Fax: I E -mail: • Reconnect only 1
Owner installation: The installation is being made on property I own Temporary services or feeders - .
which is not intended for sale, lease, rent, or exchange according to • installation, alteration, orrelocation:
200 amps or less 2
ORS 447, 455, 479, 670, 701.
201 amps to 400 amps 2
Owner's signature: Date: 401 to 600 am .s 2
ENGINEER Branch circuits - new, alteration,
or extension per panel:
Name: A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit .2
Ci I State: . I ZIP: B. Fee for branch circuits without purchase
Phone: Fax: E -mail: of service or feeder fee, first branch circuit: / 1 11 if 2
Each additional branch circuit: / (PL<
PLAN REVIEW (Please check all that Me. (Service or feeder not included):
O Service over 225 amps- commercial • 0 Health -care facility Each pump or irrigation circle 2
0 Service over 320 amps- rating of 18x2 0 Hazardous location Each sign or outline lighting 2
family dwellings 0 Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
0 System over 600 volts nominal more residential units in one structure alteration, or extension* 2
0 Building over three stories 0 Feeders, 400 amps or more *Description:
0 Occupant load over 99 persons 0 Manufactured structures or RV park Each additional inspection over the allowable In any of the above:
O Egress/lightingplan O Other. Per inspection I I- I
Submit sets of plans with any of the above. investigation fee EXPIRED
The above are not applicable to temporary construction service. Other
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application
Permit fee $ _ 53.5t) —
O Visa 0 MasterCard expires if a permit is not obtained Plan review (at _ %) $
Credit card number: I / within 180 days after it has been State surcharge (8 %) $ —C t. A 0
Expires accepted as complete. TOTAL $ 5"7 – 7 e
Name of cardholder as shown on credit card '
$
Cardholder signature Amount 440 -4615 (6/00/COM)