Permit •
r7 CITY OF TIGARD ELECTRICAL PERMIT •
PERMIT #: ELC2006 -00515
111 DEVELOPMENT SERVICES DATE ISSUED: 9/13/2006
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 1S135BD
SITE ADDRESS: 09780 SW SHADY LN 110 ZONING: C -G
SUBDIVISION: SHADY LANE OFFICE LOT : JURISDICTION: TIG
Project Description: 12 branch circuits. EDGE FINANCIAL
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: 11 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:
LEWIS, GLORIA M + ALLIED ELECTRIC
LEWIS, GLORIA M TRUSTEE + PO BOX 1640
LEWIS, ANDREW M ET AL NORTH PLAINS, OR 97133
PORTLAND, OR 97225
Phone: Contact #: PRI 614 -8000
FEES
Description Date Amount Reg #: ELE 34 -112C
[ELPRMT] ELC Permit 9/13/2006 $120.00 LIC 38538
[TAX] 8% State Surcharge 9/13/2006 $9.60 SUP 3195S
Total $129.60 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 OU C at 503 - 246 -6699 or
1- 800 - 332 -2344.
Issued By: At/ l^f cif , �( � • Permittee Signature: X
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.
•
•
[
Electr,� ^al Permit App ' 'ai . wE ` bolt OFFICE USE ONLY
I lam.
Received
City of Tigard Date/B . q 3 01, • • PermitNo.: 6,)-ooh _005
° 13125 SW Hall Blvd., Tigard,Si 72 20
C Plan B . Other Permit:
T1cnkt�
Phone: 503.639.4171 Fax: 503.59§�I9�, Date/
I nspection Line: 503639.4 l7 % Vr f I GAR D N
DIVISI Date Ready/By: riiiM ®See Page 2 for
Internet: www.tigard or.goi3UILDING Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction 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
❑ Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION ['Addition of new motor load of ❑ "A ", "E ", "I -2 ", "l -3 ",
9760 I OOHP or more. oceapaney.
Job no.: Job site address:
` S )/Ady Lu ❑ Six or more residential units. ❑ Recreational vehicle parks.
City / State/ZIP: ''V I ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: 11 Project name: ' C F- i v NC A ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qtr. I Fee. I Totd 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'I 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: 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 1 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 si afore: Date: Branch circuits — new, alteration, or extension, per panel •
A Fee for branch circuits with •
❑ APPLICANT I 0 CONTACT PERSON above service or feeder fee, I t
6.65 13.6 2
each branch circuit \
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee 46.85,,g6 2
first branch circuit
Address: Each add'I branch circuit 6.65 2 • .
Miscellaneous (service or feeder not included)
City /State/ZIP: Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Phone: ( ) Fax: : ( ) Reconnect only 66.85 2
E - mail: Pump or irrigation circle • 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
,' Signal circuit(s) or limited- •
Business name: i n / E4 'c 6 CC.Ti4L[�G energy panel, alteration, or
Address: fi, 5exe 16,IQ extension. Describe: Page 2 2
City/ State/ZIP: NU1a_n PUL IA Each additional inspection over allowable in any of the above
�� Per inspection 62.50
Phone: ( ) bit/ -F-01rn Fax: ( ) eat- 1/ .& 6 Investigation per hour (l hr min) 62.50
CCB Lic.:3 3 $ -66 Electrical Lic.: a // IL Suprv. Lic.: - 6 s S Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, require . J 0 - 1 - Oi Subtotal: hg(). '
Print name: Date: Plan review (25 %ofpermit fee):
State surcharge (8% of permit fee): v. (%9
Authorized signature: TOTAL PERMIT FEE: 1 a-i:1, (00
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 \Permiis\ELC- PemniiApp.doc 05/23/06 440- 4615T(11 /05 /COM/WEB
•
Electrical Permit Application - City of Tigard
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*
•
El 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:
El Audio and Stereo Systems
El Boiler Controls
❑ Clock Systems
El Data Telecommunication Installation
❑ Fire Alarm Installation
El HVAC
El Instrumentation
El Intercom and Paging Systems
El Landscape Irrigation Control*
❑ Medical
El Nurse Calls
El Outdoor Landscape Lighting*
•
El Protective Signaling
El Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I:\ Building \Pamits\ELC- PerrnitApp.doc 0323/06
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2006.00515
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/13/2006
Phone: (503) 639 -4171 tg -i
Inspection Requests (24 Hrs.): (503) 639 -4175 E '� � ..
INSPECTION WORKSHEET FOR DATE: 9/28/2006 TIME: 7 :02AM PAGE: 6
SITE ADDRESS: 09780 SW SHADY LN 110 CLASS OF WORK:
SUBDIVISION: SHADY LANE OFFICE LOT #: TYPE OF USE:
PROJECT NAME: EDGE FINANCIAL
DESCRIPTION: 12 branch circuits. EDGE FINANCIAL
OWNER: LEWIS, GLORIA M +, PHONE #:
CONTRACTOR: ALLIED ELECTRIC Rs) N3 PHONE #: 614 -8000 '
Inspection Request Scheduled For: Date: 9/28/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 037330-01 503-816 -4500 Y
Corrections /Comments /Instructions:
Q__
l
$PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: ,v 606 Date:1 1 0 ‘ Phone #: (503) 718- Z
•
CITY OF TIGARD
- - BUILDING DIVISION PERMIT #: ELC2006 00;15
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/13/2006
Phone: (503) 639 -4171 4
Inspection Requests (24 Hrs.): (503) 639 -4175 .. 1L.
INSPECTION WORKSHEET FOR DATE: 9/14/2006 TIME: 7 :00AM PAGE: 1
SITE ADDRESS: 09780 SW SHADY LN 110 CLASS OF WORK:
SUBDIVISION: SHADY LANE OFFICE LOT #: TYPE OF USE:
PROJECT NAME: EDGE FINANCIAL
DESCRIPTION: 12 branch circuits. EDGE FINANCIAL
OWNER: LEWIS, GLORIA M +, PHONE #:
CONTRACTOR: ALLIED ELECTRIC PHONE #: 6148000
Inspection Request Scheduled For: Date: 9/14/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
125 Wall over 036548 -01 503-816.4500 N
Corrections/Comments/Instructions:
CI PactviDr ur41 NQ MEW& (6 015 7 b
fat, P 3T trite iN A re es s
- 0 0 AZCY CNER ce t L ,T L i1evvi7 is‘ v
,p D Ae N ^L Fog.. Lim. - 10b Qv-a/6 .
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coAPerem (Li oil; ciL &i i bN
F►n1 /1.-- -
*PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: U6 1--f Date: 9 I y W Phone #: (503) 718 - 244