Permit CITY TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT -
PERMIT #: ELR2006 -00108
DEVELOPMENT SERVICES DATE ISSUED: 5/25/2006
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 1 S135DD -00600
SITE ADDRESS: 11831 SW PACIFIC HWY ZONING: C -G
SUBDIVISION: HOFFARBER TRACTS NO.2 LOT: 040 JURISDICTION: TIG
Project Description: T -stat.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: • CLOCK: MEDICAL:
HVAC: DATAfTELE COMM: NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: HVAC: X PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
YOUNG'S FUNERAL HOME INC ARROW MECHANICAL
11831 SW PACIFIC HWY 10330 SW TUALATIN RD
TIGARD, OR 97223 TUALATIN, OR 97062
Phone: Contact #: PRI 503- 692 -1565
FEES Reg #: ELE 34 -47CLE
LIC 5193
Description Date Amount
[TAX] 8% State Surcha 5/25/2006 $6.00
[ELPRMT] ELR Permit 5/25/2006 $75.00 REQUIRED ITEMS AND REPORTS
Total $81.00
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 folio ules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. .0 may obtain copies of these
rules or direct questions to OUNC at 503 - 246 -6699.
Issued By: --2- '��rw.As 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 rule 01:1- t SE 01,1
b City of Tigard RECEIVED
A Received ,
' -_ / , ►, /... M
Date/ :
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax 503.598.1 " "' k �: ' Date/B : Other Permit:
Inspection line: 503.639.4175 2 5 2006
sp - _, � • � i t Date ReadyBy: ®See Page 2 for
Internet: www.ci.tigard.or.us CITY OF TIGARD Notified/Method: II MI Supplemental information
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l - �. - �3� 'T. . 4 � .. , x n :. e �� � - k: '" 1> �i; "s; ,. � . s � x >y"; < ` � . � { v f,l�.g W ,t�, r %�Y,• y: ' 3:.
- qt "�� >, � _. .r �..,., n...,:�' -4 :'!, e _ . -a vJ ,. `ir_ - ^tii: .., . -rT. 'Re:�% -�' �.. - - 4����`�_ -TS
❑ New construction Addition/alteration/replacement Please check all that apply:
on Other. ❑ Service over 225 amps, comm'l ❑ Hazardous location
13 Demolition .k: -, r sn` �. ❑ Service over 320 amps - rating 0 Buildng over 10,000 sq. ft.,
,3 x a �a ��= _..: = k, of 1 -and 2-family dwellings or more new residential
' �:. . � i .` : V- .. _,.- . .,.- M
...:., . ,.. .,'V,- ,v'• >'�•:a . 1,h.;�Y..o. li�s
❑
:,o 1 - an 2- family dwelling - Commercial/industrial ❑ Accessory building System over 600 volts nominal units in one structure
❑ Multi - family / u Master builder ❑ Other: 0 Building over three stories 0 Feeders, 400 amps or more
. ❑ Occupant load over 99 persons O Manufactured structures or
z% �� * r s
.4i.f ,,:4P `•,, I k 1 , l;. ^ya ..)ar - a y 4. e; ❑Egresa/ligbtingplan RV park
Job no.: Job site address: g3 !nJ J �/> Hi-v.
Submit h care facility ❑ ��
/ Submit 2 seta of plans with any of the above -
City/State/ZIP: The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: Project name: '° •
Description Qty. Fee. Total
Cross street/directions to job site:. New residential single- or multi -family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea. add'1500 sq. it or pcution 33.40 1
Tax map/parcel no.: Limited energy residential 75.00 2
•
i " b G g h; - , yh r F , F. ,�, a s f;? 4 Limited energy, non - residential 75.00 2
. ' 'ma�, "�; : -i- - ''-�,. ' - ° ` ' '" Each manufactured or modular
`nay , .43+:-(ii o lk'i.,1 : : .. ,t K' g� -y :E;'t`!,k, -; �1 � ''��[ ^,
fir• 3 %+��e'n, ;.y � ±r:�Y� i� ?'.'��.- - � �fi, w ?s�' �
dwelling, service and/or feeder 90.90 2
'n r4 r �/ �� Services or feeders installation, alte on, and/or relocation
200 amps or less ' 80.30 2
< - _ - u ^ : r, -: s • , • , :i,,;4 �: ' � ", t,{F •i� ,1 , x 4... -.s�. F � „ 3 ; ..• -. ' 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160,60 2
Name: t? L i'li'&5 AA L.. Aio -ve 601 amps to 1,000 amps 240.60 2
/i 8 3 f S w FAG/ / t✓ A? w 7
Over 1,000 amps or volts 454.65 2
Address:
Reconnect only 66.85 2
City /State/ZIP: fj �-• t7 ��3 Temporary services or feeders installation, alteration, and/or
/
Phone: (52.'3) ( 3 ?_../ I Fax: ( ) relocation
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, tent, 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
; - • w ' x "`` ' ; : ws. , ,, „ . - A. Fee for branch circuits with
„ . .. �" ,, 7 :`'
g - ,, , -4' - 1!1 `' {u,2t,I.,6
° , . . r`' ` service of feeder fee, each
Business name: ARge,j tizeci AN L. , branch circuit 6.65 2
sg
B. Fee for branch circuits
Contact name:
Tc.p.rz Fe_44 /2.. without service or feeder fee,
46,85 2
first branch circuit
Address: /6)3 5e::,. s W TUz 7 -//i :c Each add'l branch circuit 6.65 2
City /State/ZIP: Tad e...4 *--/Ai �c G'� �,a Miscellaneous (service or feeder not Included)
Pump or irrigation circle 53.40 2
Phone: (S- �) & f z...- / r(o / I Fax: : (e ) ( 9 / l-8 7 Sign or outline lighting 53.40 2
E - mail: Signal circuit(s) or limited-
- Na, "'; r7' c ::.5- .,; :: ,,.t` -a,1" >ns .� t n , � ia, i -= ;; .' '`: <r%:',"� -:
f,d: -2 - 11- : �' � enef el, alteration .?:itr. 5 :'- :..- ? `�' ti �� '�`a +• '�` v „ -.... . .�.} � �+ a r' ^ '� # ��' ^ ��� � ;: ct�" `}s" 8Y 1)8I1 or
c
Business name: 4 ,,w Yt' l extension. Describe: / Page 2 2
Address: J � / L Each additional inspection over allowable in any of the above
Per inspection 62.50
City /State/ZIP: Investigation per hour (1 hr min) 62.50
Phone
( ) F ( ) Industrial p lant per hour 73.75 t
CCB Lic.: ."..-/ 9 3 ElectricalLic.: 3 (/_ C/ � u ¢ 2.5 Suprv. Lic.: - Subtotal ` 7� 6 4
Suprv. Electrician signature, required: Plan review (25% of permit fee)
Print name: - l pa; , Date: ` C ' /
State surcharge (8% of permit fee) .C.6 y W TOTAL PERMIT FEE l
Authorized signature: This permit application expires if a permit Is not obtain 180
days after it has been accepted as complete
Print name: - . %/1 �'7 I Date: < 7y 1 • Fee methodology set by Tri- County Building Industry Service Board
•• Number of inspections per permit allowed.
I,
CITY OF TIGARD , . ,
BUILDING DIVISION PERMIT #: ELR2006 -00108
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/26/2006
Phone: (503) 639- 4171i
Inspection Requests (24 Hrs.): (503) 639 -4175 ` __..
INSPECTION WORKSHEET FOR DATE: 619/2006 TIME: 7:02AM PAGE: J
SITE ADDRESS: 11831 SW PACIFIC HWY CLASS OF WORK:
SUBDIVISION: HOFFARBER TRACTS NO.2 LOT #: 040 TYPE OF USE:
PROJECT NAME: YOUNG'S FUNERAL HOME
DESCRIPTION: T - stat.
OWNER: YOUNG'S FUNERAL HOME INC, PHONE #:
CONTRACTOR: ARROW MECHANICAL PHONE #: 503- 692°1565
Inspection Request Scheduled For: Date: 6/9/2006 Pour Time:
Inspection Description Confirm # Contact # Message
9 Electrical final 031372 -01 603-793-5027 N
Corrections /Comments • tructions:
Na CA: E' ) posaes 1 t> 46e ELIP tk,
.''. c
'""'NK
XI PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: ---6 ` "6i31 L. Date: 4 ' 9 ' 02 Phone #: (503) 718- 2444