Permit CITY OF IGARD ELECTRICAL PERMIT
" PERMIT #: ELC2006 -00667
COMMUNITY DEVELOPMENT DATE ISSUED: 11/20/2006
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 25111 DD -04500
SITE ADDRESS: 15755 SW STRATFORD LP ZONING: R -4.5
SUBDIVISION: STRATFORD LOT : 013 JURISDICTION: TIG
Project Description: (1) 200 amp service.
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: 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:
BETTENCOURT WILSONVILLE ELECTRIC INC
15755 SW STRATFORD LP PO BOX 845
TIGARD, OR 97224 WILSONVILLE, OR 97070
Phone: Contact #: PRI 503 - 638 -5353
FEES
Description Date Amount Reg #: ELE 3 -307C
[ELPRMT] ELC Permit 1 1120/200( $80.30 L[C 75752
[TAX] 8% State Surcharge 11/20/2001 $6.42 SUP 3854S
Total $86,72 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, t 503.246.6699 or 1.800.332.2344.
Issued By: _ZCA/ 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.
{P Electrical Permit A • ^t' ED FOR OFFICE USE ONLY
City of Tigard Received Date/B . ew _ -I ‘ 1 Permit No.: /� `
13125 SW Hall Blvd., Tigard, OR 97223 6 Plan Revi
Phone: 503.639.4171 Fax: 503.598.19 10 `� y C 2� �" *-= `� I .. Date/B Other Permit:
Inspection Line: 503.639.4175 ik R 4 -� •' ��
Date Rea B B See Page 2 for
Q n ►_ - - Ready /By: g
Internet: www.ci.tigard.or.us Ca %T lnN Notified/Method Supplemental Information
, S 1 �.pit 4 OkK 4g
PLAN REVIEW
• ❑ New construction fit Addition/alteration/replacement Please check all that apply:
❑ Demolition ❑Other: ❑Service over 225 amps, cornm'l ❑Hazardous location
❑Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential
V I- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑ Multi - family ❑Master builder ❑Other: ❑Building over three stones ['Feeders, 400 amps or more
['Occupant load over 99 persons ❑Manufactured structures or
• JOB SITE INFORMATION AND LOCATION ❑Egress/lighting plan RV park
e P ❑Health -care facility :Other:
Job no.: Job site address: /S ..S:34..) ,3 7R 4 7cuR r Submit 2 sets of plans with any of the above.
City /State/ZIP: ` � t l g- 4 - 1 .1 1 - y The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: � Project name: FEE* SCHEDULE
Description I Qty. I Fee. I Total I '*
Cross street/directions to job site: trt� f A New residential single- or multi - family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
Tax map /parcel no.: Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular _c dwelling, service and/or feeder 90.90 2
V tt✓ Y, c -ef e-4-4/1.0 lik Services or feeders installation, alteration, and/or relocation
200 amps or less / 80.30 tri, 3 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: 8 8 el —a A Y 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 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 600 amps 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
❑ APPLICANT I ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee, 46.85 2
Address: each branch circuit
Each add'I branch circuit 6.65 2
City/State/ZIP: Miscellaneous (service or feeder not included)
Phone: ( ) F es; ; ( ) Pump or irrigation circle 53.40 2
Sign or outline lighting 53.40 2
E - mail: Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or
�'� � extension. Describe: Page 2 2
Business name: (A 6 ,L (`W itI V 6 ¢..L.E f , `i
Address: p lh ys Each additional inspection over allowable in any of the above
Per inspection 62.50
City/State/ZIP: ), L S , � Ai 1.,,._.,,:-..--- • 17 -20 � Investigation per hour (I hr min) 62.50
C . 3 ty ! Industrial plant per hour 73.75
Phone:
( `�'g ) 6 3 r s 36 3 F • %.5711 3 `' y ELECTRICAL PERMIT FEES*
CCB Lie.: , -7S -2__I Electrical • .: 3,..34, . prv. Lic.: 4r-sv_r• Subtotal Ob. 3
Suprv. Electrician signature re• . • d• - -��'� Plan review (25% of permit fee)
/tom,flA /f.�
/ � /}.. r D • e: State surcharge (8% of permit fee) 63/ '9,
Print name:
+ � ' ,4 / ��� V1, TOTAL PERMIT FEE e r 6 2
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: Date: • Fee methodology set by Tri- County Building Industry Service Board
•• Number of inspections per permit allowed.
i:' Building \Permits\ELC- PermitApp.doc 12103 440- 4615T(I0/02ICOM/WEB
Electrical Permit Application - City of Tigard a ...
•
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES: °
r RESIDENTIAL WORK ONLY:
Fee for all residential systems combined $75.00
Check Type of Work Involved:
El Audio and Stereo Systems*
❑ Burglar Alarm
El Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
❑ Other:
-- - - - - -- - - - - -- - - -- - - - - - -- - - -- - -- - COMMERCIAL WORK ONLY: Y j
ai
•
Fee for each commercial system $75.00
(SEE OAR 918 - 260 -260)
Check Type of Work Involved:
El Audio and Stereo Systems
❑ Boiler Controls
El Clock Systems
El Data Telecommunication Installation
El Fire Alarm Installation
El HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
El Landscape Irrigation Control*
El Medical
El Nurse Calls .
El Outdoor Landscape Lighting*
.
❑ Protective Signaling
❑ -Other -
Total number of commercial systems: p °.
*No licenses are required. Licenses are required
for all other installations
i:t Building \Permits\ELC- PamitApp.doc 04/03
CITY OF TIGARD dam'
• r ... ate
BUILDING DIVISION �, lb PERMIT #: ELC200 &00667
13125 SW Hall Blvd., Tigard, OR 97223 1 DATE ISSUED: 11/20/2006
Phone: (503) 639 -4171 5 t i m 1Dt; , �
Inspection Requests (24 Hrs.): (503) 639 -4175 °'I —
INSPECTION WORKSHEET FOR DATE: 12/5/2006 TIME: 7 :00AM PAGE: 34
SITE ADDRESS: 15755 SW STRATFORD LP CLASS OF WORK:
SUBDIVISION: STRATFORD LOT #: 013 TYPE OF USE:
PROJECT NAME: BE1TENCOURT
DESCRIPTION: (1) 200 amp service.
OWNER: BEITENCOURT, PHONE #:
CONTRACTOR: WILSONVILLE ELECTRIC INC PHONE #: 503- 638 -5353
Inspection Request Scheduled For: Date: 12/5/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical ' al 040633-01 503. 638 -5353 N
Corrections /Comments /Instru 'ons: a
2
__.
K,
V
A PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: ---` VV 66 L Date: 11-/C ND Phone #: (503) 718- 2::*
•