Permit A r',1-
CITY OF TIGARD.' ELECTRICAL PERMIT
PERMIT #: ELC2003 -00548
i� DEVELOPMENT SERVICES DATE ISSUED: 9/2/03
�`�'�" .. 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2 S 102AA -0280 0
SITE ADDRESS: 08770 SW SCOFFINS ST
SUBDIVISION: TIGARD HIGHWAY TRACTS ZONING. CBD
BLOCK: LOT : 026 JURISDICTION: TIG
Project Description: Install (1) 50 amp circuit to dishwasher.
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: 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: V Contractor:
TUALATIN VALLEY MENTAL HEALTH CE MID VALLEY ELECTRIC INC.
8770 SW SCOFFINS RD PO BOX 655
TIGARD, OR 97223 WILSONVILLE, OR 97070
Phone: Phone: 503 - 682 - 2955
Reg #: ELE 3 -542C
LIC 151602
FEES SUP 3483S
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 9/2/03 $46.85
[TAX] 8% State Tax 9/2/03 $3.74 Rough -in
Elect'l Final
Total $50.59
This Permit is issued subject to the regulations contained in the Tigard Muniapal 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 • • I C at (503) 246 -6699 or
1- 800 - 332 -2344.
/
Issued By: _ / / i .� Permit Signature: J., „i' ,
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 639 -4175 by 7:00pm for an inspection the next business day
Elect i1 Per D FOR OFFICE USE ONLY
l - -- -� i Received -- A Electrical __/ , , ^�7
,
Date/By: 9- ) -o .• 110Y Permit No.: e/ C= (-10 3 ����
City Tigard SEP 0 2 2003 Planning Approval Sign
Cit of Ti and Date/By: PermitNo.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 CITY OF TIGARD Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: Effloijimmslo '. Post - Review Land Use
'A \ Contact Case No.:
Internet: www.ci.tigard.or.us c! ' I Contact Juris.: ® See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 Name /Method: % ICa Supplemental Information.
TYPE OF WORK - PLAN REVIEW (Plea se check. all that apply):'.:: '•
New construction I=1 Demolition 0 Service over 225 amps- ❑ Health -care facility
commercial ❑ Hazardous location
Addition/alteration/replacement ❑Other: ❑ Service over 320 amps - rating of ❑ Building over 10,000 square feet,
CATEGORY OF CONSTRUCTION I & 2 family dwellings four or more residential units in
❑ 1 & 2- Family dwelling 2 Commercial/Industrial ❑ System over 600 volts nominal one structure
❑ Building over three stories ❑ Feeders, 400 amps or more
I=1 Accessory Building ❑ 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: B"Ti CI ft.) sc..i ,• Sk- -. - FEE* SCHEDULE • -• " - "
Suite #: I Bldg./Apt.#: Number of inspections per permit allowed
Project Name:' VV V
1 gllc.. c„,-,4.,-,s Description Qty Fee(ea.) Total
New residential- single or multi - family per
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
Limited energy, residential 75.00 2
Subdivision: I Lot #: Limited energy, non residential 75.00 2
Tax map /parcel #: Each manufactured home or modular dwelling
-
:-»: . c.i•N:" :: •- DESCRIPTION OF WORK :., . • - service and/or feeder 90.90 2
Services or feeders - installation,
nG� - �,, f L �,{ s� C� alteration or relocation:
200 amps or less 80.30 2
`- T
�■ 4 0.S1Gr 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
154.PROPERTY OWNER . ❑ TENANT ` - • •:•• . 601 amps to 1000 amps 240.60 2
.4.1...14,-. t ` Over 1000 amps or volts 454.65 2
v 0.
Name: �s on
Reconnect only 66.85 2
Address: SI-no vJ . . -- Temporary services or feeders - installation,
alteration, or relocation:
City/State/Zip: e„,„--8, . o'A ct, 200 amps or less 66.85 I
Phone: `1 2 c - o Fax: 201 amps to 400 amps 100.30 2
401 to 600 amps • 133.75 2
❑ APPLICANT -- . • .- ❑ CONTACT PERSON Branch circuits - new, alteration,or •
Name: extension per panel:
A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 6.65 2
City /State /Zip: B. Fee for branch circuits without purchase of Q
service or feeder fee, first branch circuit 1 46.85 ��, q5 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: bq k t.j 1 Signal circuit(s) or a limited energy panel,
t alteration, or extension - - Page 2 2
Business Name: (' A vA`le. ,Ne, - , L. Description: •
Address: Po t7G
" c� f ` q Each additional inspection over the allowable in an of the above:
City /State /Zip: V.. V I \ \C. 1�� Per inspection per hour (min. 1 hour) 62.50
Phone: bR;:ol -a95S Fax: b$a, -, ° Investigation fee:
CCB Lic. #: \S1boa Lic. #: ��{ _ Other: F .
Electrical;Permit. ees.. . : i .': Nr
Supervising electrician Subtotal $ L. 5
signature required: / ! Plan Review (25% of Permit Fee) S y 1,,. Z5 Print Name: M t�.t,. Cpl /. 6. c,,,_-, State Surcharge (8% of Permit Fee) S 27.
TOTAL PERMIT FEE $ (:)„5'1
Authorized HOB Notice: This permit application expires if a permit is not obtained within
Signature: Date: 9 180 days after it has been accepted as complete.
c -r �J �V Z. *Fee methodology set by Tri- County Building Industry Service Board �
1 1 CYO
(Please print name) •
i : \Dsts\Permit Forms\E1cPermitApp.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
0 Burglar Alarm
Garage Door Opener
12 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
O Boiler Controls
0 Clock Systems
O Data Telecommunication Installation
Fire Alarm Installation
HVAC
• Instrumentation
O Intercom and Paging Systems
El Landscape Irrigation Control
Medical
0 Nurse Calls
0 Outdoor Landscape Lighting
Protective Signaling
Other •
Number of Systems
* No licenses are required. Licenses are required for all
other installations
sts\Permit } rms \ElcPermitA P .doe 01/03
i\D PP 82
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line:, (5031 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested AM PM BUP
Location Ss 7 SC2.0 fi4 S S e Suite MEC
Contact Person Ph ( ) > PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner cep 3 -
Footing J ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall (\
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other: •
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
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
Service
Rough -In
UG/Slab
Low Voltage
•
- _ larm
41142 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
• RT FAIL
S Please call for reinspe tion RE: • Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date v Inspo or M _■_■,i. ` Ext
Other: i
Final DO NOT REMOVE this inspection record from the J ' site.
PASS PART FAIL