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Permit
- CITY OF TIGARD ELECTRICAL PERMIT PERMIT #: ELC2003 -00603 1V DEVELOPMENT SERVICES DATE ISSUED: 9/26/03 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 - 4171 PARCEL: 2S115CB - 04200 SITE ADDRESS: 17135 SW PACIFIC HWY ZONING: SUBDIVISION: . BLOCK: LOT : JURISDICTION: KIN Project Description: Install (7) 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: 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: 6 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: TUALATIN VALLEY FIRE & RESCUE SCHULZ ELECTRIC CO 20665 SW BLANTON 447 NE 18TH AVE ALOHA, OR 97007 HILLSBORO, OR 97124 Phone: Phone: 640 - 3304 Reg #: LIC 81488 SUP 3541S FEES ELE 34 -309C Description Date Amount Required Inspections [ELPRMT] ELC Permit 9/26/03 $87.75 [TAX] 8% State Tax 9/26/03 $7.02 Rough -in Elect'I Final Total $94.77 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 •uestions to OU C at (503) 246 -6699 or 1-800-332-2344. O Issued By: ; / _ Permit 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: 35V/5 Call 639 -4175 by 7:00pm for an inspection the next business day • • Electrical Permit Application FOR OFFICE USE ONLY Received jig_ Electrical Date/By: ( D 3 Permit No.: / COD3 00bee CI of Ti and Planning Approva Sign `J g Date/By: Permit No.: 13125 SW Hall Blvd. Plan Review Other Tigard, Oregon 97223 Date/By: Permit No.: Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post - Review Land Use Date/By: No.: Internet: www.ci.tigard.or.us ' I Inspection Request: 503 - 639 -4175 Contact Juris.: Su See Page 2 for 24 -hour Ins P Q Name/Method: Supplemental Information. (U 7X0 3 , TYPE OF WORK PLAN REVIEW (Please check all that apply) ❑ New construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility 0' Addition/alteration/replacement ❑ Other: commercial ❑ Hazardous ❑ Service over 320 amps - rating of ❑Building Building over er 10 10,000 square feet, CATEGORY OF CONSTRUCTION I & 2 family dwellings four or more residential units in ❑ 1 & 2- Family dwelling [9Commercial/Industrial ❑ System over 600 volts nominal one structure ❑ Building over three stories ❑ Feeders, 400 amps or more ❑ Accessory Building ❑ Multi- Family ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park ❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other: JOB SITE INFORMATION 3 S 5', and LOCA Submit _ sets of plans with any of the above. ` fl , W ,�Gi- e„ . e . The above are not applicable to temporary construction service. Job site address: FEE* SCHEDULE Suite #: B1d . /Apt. #: Number of inspections per permit allowed Project Name: 7 / F ,e KIM G G /ry 5 f7$ Ic Description Qty Fee (ea.) Total - Cross street/Directions to job site: New residential- single or multi - family per 1 1 dwelling unit. Includes attached garage. Service included: 1000 sq. ft. or less 145.15 4 Each additional 500 sq. ft. or portion thereof 33.40 1 Subdivision: Lot #: Limited energy, residential 75.00 2 Limited energy, non residential 75.00 2 Tax map /parcel #: Each manufactured home or modular dwelling DESCRIPTION OF WORK , service and/or feeder 90.90 2 Services or feeders - installation, 5e7-5 A-t e.... t:-L/ O G L 0 5 41 G-i1-77 iV 6 alteration or relocation: i /_ ,� p �, _ _ Dom- 200 amps or less 80.30 2 /T'!/ r LMA 201 amps to 400 amps 106.85 2 401 amps to 600 amps 160.60 2 ❑ PROPERTY OWNER I ❑ TENANT 601 amps to 1000 amps 240.60 2 Over 1000 amps or volts 454.65 2 Name: Reconnect only 66.85 2 Address: Temporary services or feeders - installation, alteration, or relocation: City /State /Zip: 200 amps or less 66.85 1 Phone: Fax: 201 amps to 400 amps 100.30 2 ❑ APPLICANT ❑ CONTACT PERSON Branch n 600 ch amps 133.75 2 c Bran circuits - new, alteration, or Name: extension per panel: Address: A . Fee for branch circuits with purchase of service or feeder fee, each branch circuit 6.65 2 City /State /Zip: B. Fee for branch circuits without purchase of service or feeder fee, first branch circuit 46.85 fob's 2 Phone: I Fax: Each additional branch circuit 6.65 3 7 ) 2 E -mail: Misc.(Service or feeder not included): CONTRACTOR Each pump or irrigation circle 53.40 2 Each sign or outline lighting 53.40 2 Job No: Signal circuit(s) or a limited energy panel, alteration, or extension Page 2 2 Business Name: SG/}i./LZ -c? �-r c C.D. / Description: Address: 0 20,313 ,v. W, etc) c. / Fk .2.P-7 City /State /Zip: �}i�� n Each additional inspection over the allowable in any of the above: 5 ii ©� t�' 02. 9 742/ Per inspection per hour (min. I hour) 62.50 Phone: -33 —0e . Fax: $ ./.0.28 Investigation fee: 4 ' 0 - CCB Lic. #: 8e/� 8 Lic. #: of -3d Other: Electrical Permit Fees* 0 Supervising electricia /O -/ -e `/ Subtotal $ 8 7.7S signature re utred: Plan Review (25% of Permit Fee) $ Print Name ph e re_k z _ Lic. # r ?.5-4,1/. --5 State Surcharge (8% of Permit Fee) $ --7 (2 TOTAL PERMIT FEE $ qy. 77 Authorized Notice: This permit application expires if a permit is not obtained within Signature: Date: 180 days after it has been accepted as complete. *Fee methodology set by Tri -County Building Industry Service Board. (Please print name) is \Dsts \Permit Forms \ElcPermitApp.doc 0 1 /03 Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: RESIDENTIAL WORK ONLY: Fee for all systems $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 system $75.00 (SEE OAR 918- 260 -260) • Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls I N • X ❑ Clock Systems • • El Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentation ▪ Intercom and Paging'Systems ❑ Landscape Irrigation Control ❑ ` • ` Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting • Protective Signaling ❑ Other � Number of Systems - • * No licenses are required. Licenses are required for all other installations ,�., ,, � � _• • i:\Dsts\Permit Forms\ElcPermitAppPg2.doc 01/03 CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 MST INSPECTION DIVISION Business Line: (503) 639 -4171 BUP Received Date Re.uested q AM PM BUP Location 1 a-C l t'Z I ) (' -mite MEC Contact Person 1 L Ph ( 50 n" (� 7OPLM Contractor Cf PhSD 3) 7 7' 4/ 3 4L03swR 7 & (/ BUILDING Tenant/Owner Ct-/ Oat 1 / (' � I /- e OW 3 -DO &c S Footing Foundation ELC Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing Insulation / Drywall Nailing (-/ (/ Fire wall Fire Sprinkler Fire Alarm 1°//121 Susp'd Ceiling f _ Roof '� J Other: Final PASS PART FAIL PLUMBING Post & Beam Under Slab Rough -In Water Service Sanitary Sewer ) �, f Qj Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: Final PASS PART FAIL MECHANICAL Post & Beam Rough -In Gas Line Smoke Dampers Final PASS PART FAIL ELECTRICAL Servi e ugh- ) `u, tl Low Voltage f " Fire Alarm F i Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. P AS ART FAIL SITE J Please call for reinspection RE: , Unable to inspect — no access Fire Supply Line ADA ■ Ext Date Insect . • A . dd ,� ' ` Approach/Sidewalk D / P Other: Final DO NOT REMOVE this inspection record fro the Job te. PASS PART FAIL