Permit .Z.65111?' CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2005 -00522
DEVELOPMENT SERVICES DATE ISSUED: 7/26/2005
� 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 1S136AD-04000
SITE ADDRESS: 11525 SW PACIFIC HWY ZONING: C -G
SUBDIVISION: VILLA RIDGE LOT : 007 JURISDICTION: TIG
Project Description: (3) 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: SIGNAUPANEL:
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: 2 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 RC COSTELLO ELECTRICAL CONTRACTING
833 NW 170TH DR PO BOX 336
BEAVERTON, OR 97006 AURORA, OR 97202
•
Phone: Phone: 503 - 982 -7400
FEES Reg #: LIC 87402
Description Date Amount ELE 3-344C
SUP 3934S
[ELPRMT] ELC Permit 7/26/2005 $60.15
[TAX] 8% State Surcharge 7/26/2005 $4.81 REQUIRED ITEMS AND REPORTS
Total $64.96
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: '7 ��4 ��:� 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.
Electrical Permit Application , , FOR Ol'FICI USE O;NI.V
City of Tigard Received
Q� Permit No.:6(C
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 ' ,' '• p . Other Permit:
Inspection Line: 503.639.4175 �_._ '� � _ D ate R ® See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method ISE Supplemental Information
TYPE OF WORK PLAN REVIEW
• ❑ New construction ❑ Addition/alteration/replacement Please check all that apply:
❑ Demolition (other: T' 0 Service over 225 amps, comm'l ❑Hazardous location
❑Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential
❑ 1 - and 2 - family dwelling �y" ommercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑ Multi - family ❑Master builder ❑Other: ❑Building over three stories ❑Feeders, 400 amps or more
❑Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION DEgress/lighting plan RV park
Job no.: Job site address: / / 5 2 s g ❑Health -care facility ❑Other:
�� - ' ' ' 4 Submit 2 sets of plans with any of the above.
City/State/ZIP: The above are not applicable to temporary construction service.
FEE* SCHEDULE
Suite/bldg. /apt.no.: Project name: .3 --/ _cif3 ,4.),/' Description I Qty. I Fee. I Total I ••
Cross street/directions to job site: New residential single- or multi- family dwelling unit.
• Includes attached garage.
1,000 sq. R or less 145.15 4
Subdivision: f Lot no.: Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
// /� w dwelling, service and/or feeder 90.90 2
—131-0,1 / i+ Cs ,r'.1 -) �,- ,(:l d.VI .. t. t-° Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: 601 amps to 1,000 amps 240.60 2
. Address: Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/ State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( - ) 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 600 amps 133.75 2
• Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
' ❑ APPLICANT I ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee, 46.85 2
Address: each branch circuit
• Each add'l branch circuit Z 6.65 - 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 -mail: Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or
extension. Describe: Page 2 2
Business 33 name: , &S 1 /< C /e� /,,,ee / da .
Address: f j d a ,z?, 33,4 additional inspection over allowable in any of the above
Per inspection 62.50
City/State/ZIP: ,4". ,„ 0 e 0 ' 7 ®0 2.,.. Investigation per hour (1 hr min) 62.50
Phone: 6 0 3 ) g9Z_'7 e 0 Fax: (5o 3) 9qL- . 74/o / Industrial plant per hour - 73.75
ELECTRICAL PERMIT FEES*
• CCB Lic.: f LOZ_ Electrical Lic.: - 3 9 c Suprv. Lic.: 3q 3 y S Subtotal
c l )---
Suprv. Electrician signature, required: C,:l' /or Plan review(25%ofpermit fee)
Print name: C & e Date: 7 /. ( State surcharge (8% of permit fee) V , W
TOTAL PERMIT FEE 6 y, 9
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: Date: • Fee methodology set by Tri -County Building Industry Service Board
•• Number of inspections per permit allowed.
i:\ Building \Petmits\ELC- PermitApp.doc 12/03 440.4615T(10/02/COM/WEB
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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 system $75.00
(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:\ BuildingTennils \ELC- PennitApp.doc 04/03
CI Y OF TIGARD
BUILDING DIVISION PERMIT #: ELC2005 -00522
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/26/2005
Phone: (503) 639 -4171 kiw d i l l
Inspection Requests (24 Hrs.): (503) 639 -4175 .� A* '..
INSPECTION WORKSHEET FOR DATE: 9/8/2005 TIME: 7:09AM PAGE: 68
SITE ADDRESS: 11525 SW PACIF C HWY CLASS OF WORK:
SUBDIVISION: PACIFIC TERRAC LOT #: 007 TYPE OF USE:
PROJECT NAME: FAST SIGNS
DESCRIPTION: (3) branch circuits.
OWNER: SMITH, EDITA M, PHONE #:
CONTRACTOR: RC COSTELLO ELECTRICAL C+ TRACTING PHONE #: 503 -982 -7400
Inspection Request Scheduled For: Date: 9/8/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 015156 -01 503- 706 -3211 Y
r
Corrections /Comments /Instructions:
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*PASS ❑ PARTIAL APPROVAL ❑ CANCEL El NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: �- 1 yd L- Date: 9( 'Si Phone #: (503) 718 - Z-44 -