Permit e .
CITY OF TIGARD ELECTRICAL PERMIT
° PERMIT #: ELC2007 -00157
COMMUNITY DEVELOPMENT DATE ISSUED: 3/14/2007
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S 101 DA -00800
SITE ADDRESS: 07105 SW VARNS ST 100 ZONING: C -P
SUBDIVISION: VARNS ACRES LOT : 011 JURISDICTION: TIG
PROJECT: VARNS STREET BUILDING
Project Description: TI - (2) branch circuits.
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: 1 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:
SYMONDS EVANS & COMPANY PC DICKINSONS ELECTRIC
7105 SW VARNS RD SUITE 200 8449 SW BARBUR BLVD
TIGARD, OR 97223 PORTLAND, OR 97217
Phone: 503 - 597 -7350 Contact #: PRI 503 - 246 - 3550
FAX 503 - 213 -6049
FEES
Description Date Amount Reg #: ELE 26 -140C
[ELPRMT] ELC Permit 3/14/2007 $53.50 LIC 65534
[TAX] 8% State Surcharge 3/14/2007 $4.28 SUP 3100S
Total $57,78 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 • .. . TTENTION. Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in
OAR 952 -0' - 0010 throu• OAR 95 ' 01 -0100. You may obtain copies of these rules or direct questions to OUNC at 503.4 • S 5.332.2344.
Issued ,% P ermittee 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 I LATION 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.
Elektrieal Permit Application FOR OFFICE USE ONLY
City of Tigard R eceived 5 / Q 7 Permit No. 1 IA) 7 aai,5
Date/By
13125 SW Hall Blvd , Tigard, OR 97223 Plan Review
C . Phone 503.639 4171 Fax 503 598 1960 Date/By Other Permit
f I G A It D Inspection Line 503.639 4175 Date Ready/By orris lid See Page 2 for
Internet. www tigard -or gov Notified/Method. 1 V Supplemental Information
TYPE OF WORK PLAN REVIEW
Please check all that apply (submit 2 sets of plans whtems checked below)
❑ New construction , Addition/alteration/replacement
❑ Service or feeder 400 amps or more ❑ Building over three stones
❑ 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
JOB SITE INFORMATION AND LOCATION
CI Emergency system larger separately denved system
❑ Addition of new motor load of ❑ "A ", "E ", "I -2 ", "l -3 ",
Job no.: Job site address: [ — S , / C v, IOO or more. Recreational 7/�� zJ L ❑ Six or more residential units ❑ Recreational vehicle parks
City/State /ZIP: ❑ Health -care facilities ❑ Supply voltage for more than
❑ Hazardous locations 600 volts nominal
Suite/bldg. /apt. no.: /00 Project name: ■ftg 5r 6i-w, ❑ Service or feeder 600 amps or more
FEE SCHEDULE
Cross street/directions to job site: Descripdon
I Qty. I Fee. I Total I •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Ea add'I 500 sq. ft. or portion 33 40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft )
t, Limited energy, multi - family
. i Air 4/. /// a Ia1 ~i' residential (with above sq ft) 75.00 2
V Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER ❑ 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: ( ) I 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 599 amps 133 75 2
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A Fee for branch circuits with
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee, • 46 85 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: ( ) I Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53 40 2
y 11 Signal circuit(s) or limited-
Business name:
! G �/LL ��7� energy panel, alteration, or
Address: g tit? 5 S e c, /3 6 extension Describe. Page 2 2
City/State /ZIP: gA' � / 5 - /61/ /4 , Each additional inspection over allowable in any of the above
Phone: ( f U3 2 ( F ax: 9 � / 2— Per t 62.50
� Z Z ( J S 'b Ali 3 � v 9 Investigation per hour (I hr mm) 62 50
CCB Lic.: 6 Electrical Lic.: ' /, 4i Suprv. Lic.: 3/ (20 Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required:' Subtotal. 5 3.
Print name: /' Date: Plan review (25% of permit fee): j/
State surcharge (8% of permit fee): 7 • ��
Authorized signature: TOTAL PERMIT FEE: 57. 7%
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
• Number of inspections allowed per permit.
1•\ Building \Permits\ELC- PermitApp doe 05/23/06 440-4615T(I I /05 /COM/WEB
Electrical Permit Application - City of Tigard • •
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:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY: 1
Fee for each commercial $75.00
system
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
Fl Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I \Budding\Permits\ELC- PermiApp doc 03/23/06
CITY OF TIGARD
BUILDING DIVISION / PERMIT #: ELC2007 -00157
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/14/2007
Phone: (503) 639- 4171�
Inspection Requests (24 Hrs.): (503) 639 -4175 ":..
INSPECTION WORKSHEET FOR DATE: 8/14 /2007 TIME: 7:00AM PAGE: 3
SITE ADDRESS: 07105 SW VARNS ST 100 CLASS OF WORK:
SUBDIVISION: VARNS ACRES LOT #: 011 TYPE OF USE:
PROJECT NAME: VARNS STREET BUILDING
DESCRIPTION: TI - (2) branch circuits.
OWNER: SYMONDS EVANS & COMPANY PC, PHONE #: 503 -597 -7350
CONTRACTOR: DICKINSONS ELECTRIC PHONE #: 503-246-3550
Inspection Request Scheduled For: Date: 8/14/2007 Pour Time:
Code # Inspection Description •nfirm # Contact # Message
130 Ceiling cover 053967 -01 03-740-7340 N
C orrections/ 1 nstructions:
ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: �Yy ®" ` Date: tif( QJ Phone #: (503) 718- Z'1
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2007 -00157
. A
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/14/2007
Phone: (503) 639 -4171 j1
Inspection Requests (24 Hrs.): (503) 639 -4175 F__..
INSPECTION WORKSHEET FOR DATE: 7/24/2007 TIME: 7 :00AM PAGE: 14
SITE ADDRESS: 07105 SW VARNS ST 100 CLASS OF WORK:
SUBDIVISION: VARNS ACRES LOT #: 011 TYPE OF USE:
PROJECT NAME: VARNS STREET BUILDING
DESCRIPTION: TI - (2) branch circuits.
OWNER: SYMONDS EVANS & COMPANY PC, PHONE #: 503 -597 -7350
CONTRACTOR: DICKINSONS ELECTRIC PHONE #: 503 - 246-3550
Inspection Request Scheduled For: Date: 7/24/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 052610.01 503-740 -7340 N
Corrections /Comments/ Instructions:
OR 4 I cs Li N 71.. N t f ► 60 A00
40.Boicl,u o►L. Q C.. c.63 N°\ ,K
fir ► N P.L.•
The electrical installation defects noted
on this report shall be corrected and
an inspection request made within 20
calendar days per OAR 918 -271 -0030
❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL ACALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: ` ` �g Date: Z I 1 718- Phone #: (503) 718 -14
CITY OF TIGARD •
BUILDING DIVISION PERMIT #: ELC2007 -00157
13125 SW Hall Blvd., Tigard, OR 97223 - DATE ISSUED: 3/14 /2007
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 y� ..
INSPECTION WORKSHEET FOR DATE: 3/16/2007 TIME: 7:01AM PAGE: 9
SITE ADDRESS: 07105 SW VARNS ST 100 CLASS OF WORK:
SUBDIVISION: VARNS ACRES LOT #: 011 TYPE OF USE:
PROJECT NAME: VARNS STREET BUILDING
DESCRIPTION: TI - (2) branch circuits.
OWNER: SYMONDS EVANS & COMPANY PC, PHONE #: 503-597-7350
CONTRACTOR: DICKINSONS ELECTRIC PHONE #: 503 - 24&3550
Inspection Request Scheduled For: Date: 3/16/2007 Pour Time:
Code # Inspection Description Co. • •• • .� Contact # Message
-- 044971 -0 503 - 516 -2922 N
i 25' w• LL Co V (L.. 0 NI ?
Corrections /Comments /Instructions:
y <ASS El PARTIAL APPROVAL El CANCEL El NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: G • N 66 L-t Date: Si I (40 Phone #: (503) 718- 4110