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Permit CITY OF TIGARD ELECTRICAL PERMIT PERMIT ISSUED: 12 1 0 /200 70830 COMMUNITY DEVELOPMENT DATE ISSUED: 12/10/2007 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 1S136DB-02501 SITE ADDRESS: 11632 SW PACIFIC HWY ZONING: C - G SUBDIVISION: LOT : JURISDICTION: TIG PROJECT: WESTSIDE ACADEMY Project Description: Repair conduit to meter. Job No. 2696 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: 1 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: WESTSIDE HOLDING CO LLC PHOENIX ELECTRIC BY MELLANIE HENIFF PO BOX 14037 11632 SW PACIFIC HWY PORTLAND, OR 97293 TIGARD, OR 97223 Phone: Contact #: PRI 503 - 886 - 9930 FAX 503 - 266 -8394 FEES Description Date Amount Reg #: ELE C89 [ELPRMT] ELC Permit 12/10/200' $80.30 LIC 162753 [TAX] 8% State Surcharge 12/10/200' $6.46 SUP 51695 Total $86.76 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 9 i • • • throug a • 952- 001 -0100. You may obtain copies of these rules or direct questions to OUNC at 503.246.6699 1.800.332.2344. /� Issue. By: it + �����L� Permittee Signature h 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: COFACTOR I -TAsI TION ONLY SIGNATURE OF SUPR. ELEC'N: h / . R _ 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. • Eltctrical Permit Application FOR OFFICE USE ONLY �• Received Permit No.: City of Tigard Date/By: /' /D 07 X 007— 30 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review C Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit: T I G A It D Inspection Line: 503.639.4175 Date Ready/By: Juris: ® See Page 2 for Internet: www.tigard - or.gov Notified/Method: Supplemental Information TYPE OF WORK PLAN REVIEW Please check all that apply (submit 2 sets of plans w /items checked below): ❑ New construction I A dition/alteration /replacement ❑ 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. I �� ( less to ground, or exceeds 14,000 ❑ Commercial -use agricultural ❑ 1- and 2- family dwelling ommercial /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. A ❑ Addition of new motor load of ❑ "A ", "E ", "1- 2 ", "l -3 ", Job site address: / ? /,� IOOHP or more. occupancy. Job no.: ado gee, //(33 _,.,..i / p-'c ❑ Six or more residential units. ❑ Recreational vehicle parks. City/State /ZIP: -2744-0:D ® 97,94( ❑ Health -care facilities. ❑ Supply voltage for more than ❑ Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: Project name: aj 1 .5 7 - 6 , I] E A „ i r ❑ Service or feeder 600 amps or more. � FEE SCHEDULE Cross street/directions to job site: Description I Qty. I Fee. I Total I • New residential single- or multi- family dwelling unit. Includes attached garage. Subdivision: I Lot no.: 1,000 sq. ft. or less 145.15 4 Ea. add'I 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 ke -Cik i ige—% ' XISTZ , e-- — ,L4/9"'g d ielte 1 residential (with above sq. ft.) 75.00 2 Services or feeders installation, alteration, and/or relocation 200 amps or less / 80.30 1(0.33 2 ❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2 Name: 401 amps to 600 amps 160.60 2 601 amps to 1,000 amps 240.60 2 Address: Over 1,000 amps or volts 454.65 2 City/State /ZIP: Temporary services or feeders installation, alteration, and/or relocation Phone: ( ) 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 ❑ CONTACT PERSON above service or feeder fee, 6.65 2 each branch circuit Business name: B. Fee for branch circuits Contact name: without service or feeder fee, 46.85 2 first branch circuit Address: Each add'I branch circuit 6.65 2 Miscellaneous (service or feeder not included) City/State /ZIP: Each manufactured or modular dwelling, service and/or feeder 90.90 2 Phone: ( ) I Fax: : ( ) Reconnect only 66.85 2 E -mail: Pump or irrigation circle 53.40 2 CONTRACTOR Sign or outline lighting 53.40 - 2 Signal circuit(s) or limited - Business name: f j s4 . /„,1_42 - 4_./ C.... energy panel, alteration, or Address: , , O Acria_f_flp / 140 5 7 extension. Describe: Page 2 2 City/State /ZIP: o, 5`77 3 Each additional inspection over allowable in any of the above � Per inspection 62.50 Phone: ( )3) ii6 l 9 77 v I Fax: (03) Investigation per hour (1 hr min) 62.50 CCB Lic.: /6? 75 3 Electrical Lic.: e 9 S u rv. L : _57 65. S Industrial plant per hour 73.75 ELECTRICAL PERMIT FEES Suprv. Electrician signature, require lte/ Subtotal: ,� / J $0,30 $0,30 Plan review (25% of permit fee): Print name: ! �/ Date: �a _ / 07 State surcharge (8% of permit fee): /f Authorized signature: ` TOTAL PERMIT FEE: i/_ a J This permit application expires if a permit is not obtained within 180 - Print name: 0L 1j // Date: X� 0, days after it has been accepted as complete. �� ' °� (/ • Number of inspections allowed per permit. 1: \ Building \Permits\ELC- PermitApp.doc 05/23 /06 440- 4615T(I I /05 /COM/WEB 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: I COMMERCIAL WORK ONLY: 1 Fee for e commercial $75.00 system (SEE OAR 918- 260 -260) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls n 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 'Permits\ELC- PermitApp.doc 03/23/06 CITY OF TIGARD BUILDING DIVISION PERMIT #: ELC2007- 00830 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 12/10/2007 Phone: (503) 639 -4171 �f �''� Inspection Requests (24 Hrs.): (503) 639 -4175 , ''- I.. INSPECTION WORKSHEET FOR DATE: 12/11/2007 TIME: 7:OOAM PAGE: 15 SITE ADDRESS: 11632 SW PACIFIC HWY CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: VVESTSIDE ACADEMY DESCRIPTION: Repair conduit to meter. Job No. 2696 OWNER: WESTSIDE HOLDING CO I-LC, PHONE #: CONTRACTOR: PHOENIX ELECTRIC T E. (“ \/ PHONE #: 503 Inspection Request Scheduled For: Date: •12J1•1/2007 Pour Time: Code # Inspection Description Confirm # Contact # Message 199 Electrical final 061289 -01 503-886-9930 Y Corrections /Comments /Instructions: SVRVAc --. © Sle . K. PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: cZ Nvd Date: VA I s tri Phone #: (503) 718 -1-4 1