Permit Ipi- , CITY OF TIGARb ELECTRICAL PERMIT
PERMIT ISSUED: ELC5/20070730
COMMUNITY DEVELOPMENT
DATE ISSUED: 10/25/2007
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S 102BD -00500
SITE ADDRESS: 12705 SW PACIFIC HWY ZONING: C -
SUBDIVISION: NO.TIGARDVILLE ADDITION AMEND. _ LOT : 050 JURISDICTION:.
PROJECT: ADRANGI
Project Description: Electrical work to correct unsafe wiring, (2) 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: SIGNAL/PANEL:
MANF HM/ SVC/ FDR: 601 +amps -1000 volts: MINOR LABEL (10):
SERVICE/FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: i 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: O .. 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:
FARID ADRANGI M & M ELECTRICAL SERVICE INC. '
4289 SW ORCHARD WAY PO BOX 33706
LAKE OSWEGO, OR 97035 PORTLAND, OR 97292
Phone: 503 - 697 -0597 Contact #: PRI 503 - 771 -8200
FEES
Description Date Amount Reg #: ELE 26 -123IC
[ELPRMT] ELC Permit 10/25/200" $53.50 LIC 161691
[TAX] 8% State Surcharge 10/25/200 $4.28 SUP 4921 S
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 th days TENTION• Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in
OAR 2- 001 -0010 through, A 9 2 o1 -0100. You may obtain copies of these rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
Is
d By: I C 0.06/4, Permittee Signature: )( 16
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:
CONT ACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: V (141 V6 `- 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.
Elect Permit Application FOR OFFICE USE ONLY ;;� /�,��,
City of Tigard Date/By: /0 �S o7 P No.: FLO t X 7.. Q, 750
II P4 13125 SW Hall Blvd., Tigard, O 97223 Plan Review
' C . Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit:
Inspection Line: 503.639.4175 Date Ready/By: . ia See Page 2 for
TIGARD
Internet: www.tigard - or.gov i . �.07 —vp 7? -3 Notified/Method: '/
1. Ca Supplemental information
TYPE OF WORK PLAN REVIEW
❑ New const ruction [ 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
❑ 1 - 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 LOCATIO
13 Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "I -2 ", "l - ",
Job no.: Job site address: ( O Z� SW '`
Gi C ��y ❑ Six or Six or residential or occupancy.
more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: 1 a • ❑ Health-care facilities. ❑ Supply voltage for more than
O I - ❑Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: i D2& 1 ❑ 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: Lot no.: 1,000 sq. ft. or less 145.15 4
Tax map /parcel no.: Ea. add', 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family 75.00 2
residential (with above sq. ft.)
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
Name: r'C
/� Oat 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: ( ) 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
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
A. Fee for branch circuits with
❑ APPLICANT I ❑ CONTACT PERSON . above service or feeder fee, a 6.65 2
each branch circuit
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee, / 46.85 1/4 Ss 2
first branch circuit
Address: Each add'I branch circuit 6.65 6.6,‹ 2
Miscellaneous (service or feeder not included)
City/State /ZIP: Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Phone: ( ) Fax: : ( ) ma 66.85 -is- 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Business name: E M 08 " GI e i a) or t o n , or
l✓ �/ C � / S energy noel, alteration, or
Address: Po., dx 3 3 7 G` extension. Describe: Page 2 2
°l am
City/State /ZIP: ' Q� /„ v10 Q/ q � Each additional inspection over allowable in any of the above
Phone:
(3 7// 8 0 0 ( Y Fax: ( 77 COO Per inspection 62.50
�3 ) � � Investigation per hour (I hr min) 62.50
CCB Lic.: / (/6 ?/ Electrical Lic.: a 023 f 4uprv. Lic.: 41 Industrial plant per hour 73.75
/ ELECTRICAL PE FEES
Suprv. Electrician signature, required: ®w - Subtotal: 535C)
Print name: P14/2 SUS /`s, /C/y/f L. Date: /7/2 ,5 7 Plan review (25% of permit fee):
State surcharge (8% of permit fee): Li/, 4
Authorized signature: TOTAL PERMIT FEE: 67; 7g
Print name: Date: This permit application expires if a permit is not obtained within 180
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(l1 /05 /COM/WEB
Electrical Permit Application - City of Tigard s LI.
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
El Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation •
❑ HVAC
❑ Instrumentation
El Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
El Nurse Calls
El 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 #: EIL2007 -00730
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/25/2007
Phone: (503) 639 -4171v
Inspection Requests (24 Hrs.): (503) 639 -4175 "I —
INSPECTION WORKSHEET FOR DATE: 10/26/2007 TIME: 7 :00AM PAGE: 70
SITE ADDRESS: 12705 SW PACIFIC HWY CLASS OF WORK:
SUBDIVISION: NO.TIGARDVILLE ADDITION AMEND. LOT #: 050 TYPE OF USE:
PROJECT NAME: ADRANGI
DESCRIPTION: Electrical work to correct unsafe wiring, (2) branch circuits.
OWNER: ADRANGI, FARID PHONE #: 503 -697 -0597
CONTRACTOR: M Ik M ELECTRICAL SERVICE INC. PHONE #: 603-771-8200
Inspection Request Scheduled For: Date: 10/26/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
120 Electrical rough -in 058407.Of ' 503.806-6107 " Y
Corrections /Comments /Instructions: /Q,_
Cb ?N.04 a isistki:11 ii3O‘611 Z5 Vilek° - p
Z .b. t kA 6 L -u Pawqc
EN>,^• _
s-Al <I NA-? G--(tt .)Nsbi (Ni EL:EelitsZe Ka elapcut\)VS)
1 I
N.-.‘ 1-\ N6A,IN .. ,
❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
% FAIL A CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: N d4 l..0 Date: /01 -! Q1 Phone #: (503) 718- _W)
CITY OF TIGARD ,
I BUILDING DIVISION PERMIT #: ELC2007- 00730
I 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/25/2007
Phone: (503) 639 -4171 A j •Inspection Requests (24 Hrs.): (503) 639 -4175 ,,,„J
INSPECTION WORKSHEET FOR DATE: 10/29/2007 TIME: 7 :01AM PAGE: 23
SITE ADDRESS: 12705 SW PACIFIC HWY CLASS OF WORK:
SUBDIVISION: NO.TIGARDVILLE ADDITION AMEND. LOT #: 050 TYPE OF USE:
PROJECT NAME: ADRANGI
DESCRIPTION: Electrical work to correct unsafe wiring, (2) branch circuits. 10/26/07 ADD service feeder.
OWNER: ADRANGI, FARID PHONE #: 503 -697 -0597
CONTRACTOR: M at M ELECTRICAL SERVICE INC. PHONE #: 503-771-8200
Inspection Request Scheduled For: Date: 18/29/2007 Pour Time:
•e # Inspection I - ription Confirm Contact # Message
120 Electrical rough-in 058528 -01 503- 544 -5078 N
' °I °I Fi NP t
Corrections/Comments/ nstructions: \,
1 t y 6'" - ilu ► C
Q i()
C Th PASS ❑ PARTIAL APPROVAL 111 CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: C r — i 066 Le Date: 16123161 Phone #: (503) 718- 2 ! '