Permit CITY F T I G w R D ELECTRICAL PERMIT
I r VH PERMIT #: ELC2007 -0051
COMMUNITY DEVELOPMENT DAT ISSUED: /23/2007
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1S134BD-02300
SITE ADDRESS: 11845 SW SCHOLLWOOD CT ZONING: R - 4.5
SUBDIVISION: ENGLEWOOD NO.2 LOT : 111 JURISDICTION: TIG
Project Description: Change out panel.
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: 1 W /SERVICE OR FEEDER: 10 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:
MATT WITTEN ALLIED ELECTRIC
11845 SW SCHOLLWOOD CT PO BOX 1640
TIGARD, OR 97223 NORTH PLAINS, OR 97133
Phone: Contact #: PRI 614 -8000
FEES
Description Date Amount Reg #: ELE 34 -I 12C
[ELPRMT] ELC Permit 1/23/2007 $146.80 LIC 38538
[TAX] 8% State Surcharge 1/23/2007 $11.74 SUP 3195S
Total $158.54 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 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: 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.
s
' Permit Application Received FOR OFFICE F USE ONLY
RECEIVED Planning Permit No.: C-' e% �7 ffao.) l
City of Tigard Planning Approval Sign
`J g Date/By: Permit No.:
13125 SW Hall Blvd. JAN 2 3 Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503 -639 -4171 Fax: 9'3 §65i,Ha,, Post - Review Land Use
1N( p�Ul �' •K'1 l Date/By: Case No.:
Internet: www.ci.tigard.or.us • � I Contact Juts(
24 -hour Inspection Request: 503 -639 -4175 Su See Page 2 for
P 9 Name/Method: _ Supplemental ln[ormation.
TYPE OF WORK PLAN REVIEW (Please check all that apply)
❑ New construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility
commercial ❑
Addition/alteration/replacement El Other: Hazardous
❑ Service over 320 amps - rating of 0 Building over er 10 10,000 square feet,
CATEGORY OF CONSTRUCTION 1 & 2 family dwellings four or more residential units in
1 & 2- Family dwelling ❑ Commercial/Industrial ❑ System over 600 volts nominal one structure
❑ Building over three stories ❑ Feeders, 400 amps or more
El Accessory Building El Multi- Family
❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other:
JOB SITE INFORMATION and LOCATION Submit sets of plans with any of the above.
The above are not applicable to temporary construction service.
Job site address: I I e s J. GV- 5 GNOIIWa00 L T. FEE* SCHEDULE
•
Suite #: I Bldg. /Apt. #: Number of inspections per permit allowed
Project Name: Description Qty Fee (ea.) Total
New residential- single or multi - family per 1
Cross street/Directions to job site: 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 I
Subdivision: I Lot #: Limited energy, residential 75 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
( (�
/ 1 / ,4t/6 , /i ' D v T ` ,I /�F � 1 1 Services or feeders - installation,
� alteration or relocation:
200 amps or less I , 80.30 6.10 O 2
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: _ _ • \■•. Is Reconnect only 66.85 2
Address: Temporary services or feeders - installation,
alteration, or relocation:
City /State /Zip: 200 amps or less 66.85 I
Phone: Fax: 201 amps to 400 amps 100.30 2
❑ APPLICANT ❑ CONTACT PERSON 401 to 600 amps 133.75 2
Branch circuits - new, alteration, or
Name: extension per panel:
Address: A Fee for branch circuits with purchase of
service or feeder fee, each branch circuit / 0 6.65 GG,-D 2
City /State /Zip: B. Fee for branch circuits without purchase of
service or feeder fee, first branch circuit 46.85 2
Phone: I Fax: Each additional branch circuit 6.65 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,
Business Name: A11/50 61 ee rk/ L alteration, or extension Page 2 2
Description:
Address: / o. Pa) l G y0
Ct /State /Zi (/! Each additional inspection over the allowable in any of the above:
`J P' �V '/ v �� 7 / 1,4/A IL ��' 7 / �� Per inspection per hour (min. 1 hour) 62.50
Phone;f0,' G /V. e Fax:„ . /y. llliy Investigation fee:
CCB Lic. #: ,? 8,f",, 8' Lic. #: ? / - /12 G Other:
Supervising electri Electrical Permit Fees*
P g Subtotal $ / y g, 8-0
signature required Plan Review (25% of Permit Fee) $
Print Name: (2pu ((i P Lic. #: 519 S State Surcharge (8% of Permit Fee) $ / /. 7 Y
TOTAL PERMIT FEE $ /,f)r.S%
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 01/03
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
O 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:
O Audio and Stereo Systems
▪ Boiler Controls
0 Clock Systems
El Data Telecommunication Installation
Fire Alarm Installation
HVAC
❑ Instrumentation
O Intercom and Paging Systems
❑ Landscape Irrigation Control*
Medical
O 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
BUILDING DIVISION PERMIT #: ELC2007 -00051
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/23/2007
Phone: (503) 639 - 4171s .mom'
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 3/007 TIME: 7 :00AM PAGE: 17
SITE ADDRESS: 11845 SW SCHOLLWOOD CT CLASS OF WORK:
SUBDIVISION: ENGLEWOOD NO.2 LOT #: 111 TYPE OF USE:
PROJECT NAME: wTTEN
DESCRIPTION: Change out panel.
OWNER: VV1f EN, MATT PHONE #:
CONTRACTOR: ALLIED ELECTRIC PHONE #: 614 -8000
Inspection Request Scheduled For: Date: 3/8/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
190 Electrical final 044330 -01 5 -5572 N
Corrections/Comments/Instructions:
0 PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 0 4� Date: 31 6I bi Phone #: (503) 718- M b