Permit CITY OF TIGARD ELECTRICAL PERMIT
° ► PERMIT #: ELC2008 -00230
COMMUNITY DEVELOPMENT DATE ISSUED: 4/23/2008
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S 103RD -00600
SITE ADDRESS: 11970 SW WALNUT ST ZONING: R -4.5
SUBDIVISION: LOT : JURISDICTION: TIG
PROJECT: BOYCE
Project Description: (1) additional investigation per hour.
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: PER HOUR: 1
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:
RONALD J. BOYCE ANDERSONS INTEGRITY ELECTRIC
11970 SW WALNUT ST 18435 SW PACIFIC HWY
TIGARD, OR 97223 STE D
TUALATIN, OR 97062
Phone: 503 - 524 -3052 Contact #: PRI 503 - 691 -6709
FAX 503 - 691 -6709
FEES
Description Date Amount Reg #: ELE 34 -363C
[ELPRMT] ELC Permit 4/23/2008 $62.50 LIC 91410
[TAX] 12% State Surchar 4/23/2008 $7.50 SUP 3770S
Total $70.00 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 que tions to DUN • . As .246.6699 or 1.800.332.2344.
Issued By: i -- ��` 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.
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Electrical Permit App icahon FOR OFFICE USE ONLY
; _ ; Received u n
_ . City of Tigard `A ii=" Date/By G / Of Cr, Permit No ALE ?oar_ c...6?-36 13125 SW Hall Blvd., Tigard, OR 9 ?" ' - V
. a g \ Pl an R ev i ew Other Permit '' r (r /
AL Phone. 503 639 4171 Fax 503 598.;0 . i ✓ DateDate/By Oth P EL C cxj �6 ?
ft D Inspection Line 503 639 4175 n PR Date Ready/By Suns ® See Page 2 for
1l G A
Internet. www tigard -or gov P mt 0c. T' �loufied/Method Supplemental Information
'TYPE OF 'WORW 1�c1�� Vl t CJ� PLAN REVIEW
❑ New construction Addition/alteratibfieplacement Please check all that apply (submit 2 sets of plans whtems 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
2`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'
0 Emergency system larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job no.: Job site address: I IOOHP or more occupancy
1 Q ' 1 7 0 5 " V LL� 1. J 1.LA. ❑ Six or more residential units ❑ Recreational vehicle parks
Ci ty/State /ZIP: � Q , � ❑ Health -care facilities ❑ Supply voltage for more than co, ❑ Hazardous locations 600 volts nominal
Suite/bldg. /apt. no.: Project name: ycja_ ❑ Service or feeder 600 amps or more
FEE SCHEDULE
Cross street/directions to job site: Description 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)
Limited energy, multi - family 75 00 2
( N e S p . t ot� .4-t. Ca- v .Q c.. residential (with above sq ft.)
S Services or feeders installation, alteration, and/or relocation
ec ' L e- L
( -. t C ��-Y 200 amps or less 80 30 2
❑ PROPERTY OWNER , ❑ TENANT - 201 amps to 400 amps 106 85 2
Name: gives /„/ 401 amps to 600 amps 160.60 2
"'--�t w ��- 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 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'l 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
Business name: �— � _ Signal circuit(s) or limited -
4 .\ EA r 5t i►, \ 1� }\ .e. U i• % 'c•/ �k y t C, energy panel, alteration, or
Address: ( Ca (4 3 s s ta.... ) PK_ L c ,) ./ extension Describe Page 2 2
City/State /ZI 1. � Each additional inspection over allowable in any of the above
r). C ^' v Per inspection 62 50
Phone: ( 5 q /___ G 7 O C/ Fax: ( ?3 ) G or ( _� 7 Investigation per hour (I hr min) ) 62 50 , Z . S o
CCB Lie.: G� (/ / v Electrical Lie.: 3 r C Suprv. Lic.: ^ 3 1' 7 v 5 Industrial plant per hour 73 75
ELECTRICAL 'PERMIT FEES
Suprv. Electrician signature, required Subtotal 6,2,5"
Print name: t J f 01 A000 l s. Date:q( i 09,- Plan review (25% of permit fee)
State surcharge (12% of permit fee) 7. 5
Authorized signature: TOTAL PERMIT FEE. -70 -
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 \Buddmg\Permits\ELC- PennitApp doc 05/23/06 440- 4615T(1 I/05 /COM/WEB
Electrical Permit Application - City of Tigard
•
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENT _
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:
COM MERCIAL -WORK ONLY
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ 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 0 .
Total'number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I \Butldmg\Permns\ELC- Perm0App doe 03/23/06
CITY OF TIGARD • . ,
BUILDING DIVISION PERMIT #:E200% +00230
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED:
Phone: (503) 639 -4171 U ' ` ��
��
Inspection Requests (24 Hrs.): (503) 639 -4175 `'IL
INSPECTION WORKSHEET FOR DATE: 4l 2 0 0 TIME: PAGE:
SITE ADDRESS: 11 q`10 S vA5 thA-•N 0? d 1 CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: tO\ CS •
DESCRIPTION: i
OWNER: ,` - PHONE #:
CONTRACTOR: hots:kbot. 114'Vac, -Rn1 PHONE #:
Inspection Request Scheduled For: Date: ij 1,1101 Pour Time:
Code # Inspection Description Confirm # Contact # Message
-/- ' 6 )k I FeiL ' 1 15 s ^kv l cri •
�°�� Cor coon Co britiMiglruc ions:
,4,\
c,,,,. *I d
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Cr NOJ Date: li1210t Phone #: (503) 718 - pjLf •
CITY OF TIGARD �..
BUILDING DIVISION PERMIT #: ELC2008.00230
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/23/2008
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 4/24/2008 TIME: 7:01AM PAGE: 5
SITE ADDRESS: 11970 SW WALNUT ST CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: BOYCE
DESCRIPTION: (1) additional investigation per hour.
OWNER: BOYCE, RONALD PHONE #: 503.524 - 3052
CONTRACTOR: ANDERSONS INTEGRITY ELECTRIC PHONE #: 503 - 69'1 - 6709
Inspection Request Scheduled For: Date: 4/24/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electiical final 068858 -01 503.307 -3885 N
Corrections /Comments /Instructions:
/b//
' PASS ❑ PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: G— N6E5 `--E Date: J rJ-"II 01 Phone #: (503) 718 - Z�