Permit C ITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2003 -00042
AV • I DEVELOPMENT SERVICES DATE ISSUED: 11/21/03
ref li 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 1S134DC-00700
SITE ADDRESS: 11365 SW TIGARD ST
ZONING: R - 4.5
SUBDIVISION:
BLOCK: LOT : JURISDICTION: TIG
Project Description: New construction.
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: 1
LIMITED ENERGY: 1 401 - 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: 4 W /SERVICE OR FEEDER: 103 PER INSPECTION:
201 - 400 amp: 2 1st W/O SRVC OR FDR: PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT:
601 - 1000 amp: 1 PLAN REVIEW SECTION
1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
BAPS TEMPLE WINNER ELECTRIC INC
PO BOX 41160 5950 SW PROSPERITY PK
SAN JOSE, CA 95160 TUALATIN, OR 97062
Phone: 408 - 453 - 6464 Phone: 638 -5028
Reg #: LIC 14794
SUP 2825S
FEES ELE 34 -150C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 11/21/03 $1,588.85
[ELPLCK] ELC Pln Rev 11/21/03 $397.21 Ceiling Cover
[TAX] 8% State Tax 11/21/03 $127.11 Wall Cover
Underground Cover
Total $2,113.17 Low Voltage Inspection
Elect'I Service
Rough -in
Liam' rinal
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 the- - Iles .rdi -ct qu- stions to I i C at 03)
246 -6699 or 1 -800 -3 -2344.
Issued By: ( --- t 4 ,1 _w_, 4,Aer Permit Signatur I A V
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
•
- Ele ct ical Permit Application Received —g FOR OFFI EE USE t N LY • .. • : ,:z :2
— Date/By: I — 3 I —63 Permit No.: Aoa-3 - OU() `f c .
City of Tigard Planning Approval Sign
C E I V E !�, Planning
y. Permit No. •
13125 SW Hall Blvd. V 1 � Plan Review Other
Tigard, Oregon 97223 LLee Date/By: Permit No
Phone: 503-639-4171 Fax: 503.b�►N 1i l Post- Review Land Use
Date /By: Case No :
Internet: www.ci.tigard.or.us .��� ( Contact Juris : ® See Page 2 for
24 -hour Inspection Request: 5 L �� D 'FJ
ING STIDI G " Name /Method: Supplemental Information.
�
4 P�66 - vo60
TYPE OF WORK PLAN REVIEW ( lease check all that apply)
New construction ❑ Demolition ❑ 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 1 & 2 family dwellings four or more residential units in
❑ I & 2- Family dwelling ❑ Commercial /Industrial ❑ System over 600 volts nominal one structure
❑ Building ovci three stones ❑ Feeders, 400 amps or more
❑ Accessory Building ❑ Multi- Family ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
❑ Master Builder 0 Other: --/-72-)P1-g- ❑ 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: / / 3.6 5(., -/ K r S7 • FEE* SCHEDULE
Suite #: Bldg. /Apt. #: Number of inspections per permit allowed
Project Name: H . A . P. S 7 PLLS Description Qty Fee (ea.) Total
New residential - single or multi - family per i
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 1
I Limited energy, residential 75.00 2
Subdivision: Lot #: Limited energy, non residential I 75 00 7 b .' 2
Tax map /parcel #: Each manufactured home or modular dwelling
DESCRIPTION OF WORK service and/or feeder 90 90 2
Services or feeders - installation,
alteration or relocation: ]
200 amps or less 80 30 . )`^ 2
201 amps to 400 amps y 106 85 A I 10 2
401 amps to 600 amps 160.60 2
❑ PROPERTY OWNER I ❑ TENANT 601 amps to 1000 amps 1 240 60 ,2. 0. (A 2
Over 1000 amps or volts 454.65 2
Name: $ • )-. F. S Reconnect only 66.85 2
Address: D , - RQ h y II �, D Temporary services or feeders - installation,
City /State /Zip: SA-A) 40,-, c l f . 5/ (OU / x alteration, 200 amps or or less relocation:
% 66.85 1
Phone:-_4'- g7/L 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: 7 -/2. jN 17 (Al i tr) \ extension per panel:
� v � � 4 // !OO A s e r fo or feed r fee,te each purchase of /03 6.65 68 2
Address: l/ service or feeder fee, each branch circuit
City /State /Zip: $'jl/ ` J'p , - - �� _ 5 / L B. Fee for branch circuits without purchase of
t service or feeder fee, first branch circuit 46.85 2
Phone: 503 -5 /5 - 4 / .7411 Fax: 503 2?9 -6 (P // /1 Each additional branch circuit 6.65 2
E -mail: /g i I- 5 '3 - b 74, Misc (Service or feeder not included): ,
Each pump or irrigation circle 53.40 2
CONTRACTOR
Each sign or outline lighting 1 53.40 6 .yo 2
Job No: Signal circuit(s) or a limited energy panel,
1 alteration, or extension Page 2 2
Business Name: WAbst/ /j2 aterr�IC, uo,Jf i /I/C. Description
Address: 5950 514) SPf.@ r/ k1.L tb
�O� q n Each additional inspection over the allowable in any of the above:
City/State/Zip: �� T) 010. -f 9- Per inspection per hour (mm 1 hour) 62.50
Phone: 3PJ- 618 -5 9-` Fax: Investigation fee.
CCB Lic. #: / y 9 Lic. #: if-
/50C- Other Electrical Permit Fees*
Supervising electrician Subtotal $ / 5$ `g • 85
signature required: Plan Review (25% of Permit Fee) $ ) 3
Print Name: Lic. #: State Surcharge (8% of Permit Fee) $ / X / 1
TOTAL PERMIT FEE $ X (! e / 1
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 pnnt name)
is \Dsts \Permit Forms \ElcPermitApp doe 01/03
I '
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information a
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all systems $75.00
Check Type of Work Involved:
El Audio and Stereo Systems
0 Burglar Alarm
11 Garage Door Opener*
El Heating, Ventilation and Air Conditioning System
El Vacuum Systems
O Other
COMMERCIAL WORK ONLY:
Fee for each system $75.00
(SEE OAR 918 - 260 - 260)
Check Type of Work Involved:
0 Audio and Stereo Systems
0 Boiler Controls
0 Clock Systems
O Data Telecommunication Installation
Fire Alarm Installation
n HVAC
O Instrumentation
El Intercom and Paging Systems
U Landscape lmgation Control
0 Medical
El Nurse Calls
Outdoor Landscape Lighting
0 Protective Signaling
F 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
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
RECEIVED •
WINNER ELECTRIC INC N O V 2 5
5950 SW PROSPERITY PK 2003
TUALATIN, OR 97062 BX.
•
Electrical Signature Form
Permit #: ELC2003 -00042
Date Issued: 11/21/03
Parcel: 1 S134DC -00700
Site Address: 11365 SW TIGARD ST
Subdivision:
Block: Lot:
Jurisdiction: TIG
Zoning: R-4.5
Remarks: New construction.
Your company has been indicated as the electrical contractor for the permit indicated above. In order for the
electrical permit to be valid, the signature of the supervising electrician is required. have the
appropriate individual from your company sign below and return this Electrical Signature Form 'prior to
start of the work to the address above, ATTN: Building Division.
No electrical inspections will be authorized until this completed form is received
OWNER: ELECTRICAL CONTRACTOR:
BAPS TEMPLE WINNER ELECTRIC INC
PO BOX 41160 5950 SW PROSPERITY PK
SAN JOSE, CA 95160 TUALATIN, OR 97062
Phone #: 408 -453 -6464 Phone #: 408 -453 -6464 •
638 -5028
Reg #: LIC 14794
SUP 2825S
ELE 34 -150C
AN INK SIGNATURE IS REQUIRED ON THIS FORM
. Weji
• • SigNiture of Supervising Electrician
If you have any questions, please call 503.718.2433.
CITY OF TIGARD 24 -Hour
BUILDING Inspection LIFie: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
S BUP
Received Date Requested O / 7 AM PM BUP
Location // 3 (c) Suite MEC
b � Contact Person ` Ph (? 7/ ) 3S PLM
Contractor Phf_ ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT �/�
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Drywall Nailing ,� ne � r
Dryll N /�'�T �I
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
Fire Alarm
AS PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SITE Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line .� /' 6PfL605/ ADA
Approach/Sidewalk Date Inspector M Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL