Permit A.. ( CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2005 -00158
in DEVELOPMENT SERVICES DATE ISSUED: 3/17/2005
cal 11 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 1 S1266C 01700
SITE ADDRESS: 09050 SW WASHINGTON SQUARE RD ZONING: R -40
SUBDIVISION: GEORGETOWN MANOR APT LOT : JURISDICTION: TIG
Project Description: Reconnect only.
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:
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: ' 1 SVC /FDR >= 225 AMPS: CLASS AREA/SPEC.000:
Owner: Contractor:
PRINCETON PROPERTY MGMT ( x v ►
•
7831 SE LAKE RD
PORTLAND, OR 97267
Phone: 503 - 646 -7674 Phone:
FEES Reg #:
Description Date Amount
[ELPRMT] ELC Permit 3/17/2005 $66.85
[TAX] 8% State Surcharge 3/17/2005 $5.35 REQUIRED ITEMS AND REPORTS
Total $72.20
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 vi n days of issuance, or if work is
suspended f. •• e - an 180 days. ATTENTION Oregon law requires you to follow rules adopted by the Oreg n Utility Notification Center. Those
rules a - set forth in OA •52- 001 -0010 through OAR 952 - 001 -0100 You may obtain copies of these rules o irect que • to OUNC at
503- •6 -6699 or 1- 800 -332
Iss , ed By: Permittee Signature: 1ttjA-_ . ,,C
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.
1 1 t � 4 1 z 7 , .1 ,1 i .-1.9- rr .. � t •i r .-,:,:,, :; , ,A t
Electrical Permit Application , ; 1 F OR OFFICE USE ONLY t F 31 h ,
Citg of Tigard Date /B : „Aro MB" Permit Pernut No.
13125 SW Hall Blvd , Tigard, OR 97223 Plan Review
Phone. 503.639.4171 Fax. 503.598.1960 / i�1 Date/By. Other Permit:
Inspection Line: 503 639 4175 n� Date Ready/By I�t ' 0 See Page 2 for
Internet www.ci.tigard.or us Notified/Method. / [UP Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction ❑ Addition/alteration/replacement Please check all that apply
❑ Demolition ❑ Other: ❑Service over 225 amps, comm'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
❑ 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building ['System over 600 volts nominal units in one structure
El Multi - family El Master builder El Other: ❑Buildin over three stories ❑Feeders, 400 amps or more
['Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress /lighting plan RV park
�� / f � ❑Health -care facility ['Other. Job no.: Job site address: ��O �� [d t�� f Sc.) Submit 2 sets of plans with any of the above.
City /State /ZIP. — 16 — t 7 ? 3 31 The above are not applicable to temporary construction service
Suite/bldg. /apt. no : Project name' D 6 Id ,j /11-/f FEE* SCHEDULE
Description I Qty. Fee. I Total I **
Cross street/directions to job site: 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
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
1=1 PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106 85 2
401 amps to 600 amps 160.60 2
/
Name. 0 j acc � 4 y ' /j/ � 601 amps to 1,000 amps 240.60 2
Address: ? A ( C " - r /`-'I✓ Over 1,000 amps or volts 454.65 / 2
Reconnect only / 66.85 6,6. �fb 2
City/State /ZIP: d - t% � L ,f/J Q 2 97 Temporary services or feeders installation, alteration, and /or
Phone: ?J �/ l / � 1 Fax: ( ) relocation
� (J ^ 7b / 7 200 amps or less 66.85 1
Owner installation: This installatio 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 ❑ 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,
each branch circuit 46.85 2
Address: Each add'l branch circuit 6.65 2
City/State /ZIP. Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone* ( ) Fax: ( )
Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited -
CTOR energy panel, alteration, or
extension. Describe. Page 2 2
Business name:
Address: /1/4„.:7T Each additional inspection over allowable in any of the above
Per inspection 62.50
City/State /ZIP: Investigation per hour (1 hr min) 62 50
Phone: ( ) Fax: ( ) Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES* 4 _
CCB Lic.: Electrical Lic.: Suprv. Lic.: Subtotal 66 , t'.5
Suprv. Electrician signature, required: Plan review (25% of permit fee)
Print name: Date: State surcharge (8% of permit fee) 5. 3 S /
' TOTAL PERMIT FEE 7a • 2. O
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 Tn- County Building Industry Service Board
** Number of inspections per permit allowed.
1 \Building\Permits\ELC- PermitApp doc 12/03 440- 4615T(10 /02 /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*
❑ Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
❑ Other: -
COMMERCIAL WORK ONLY:
Fee for each commercial system $75.00
(SEE OAR 918 - 260 -260)
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
- Total - number of commercial systems:
*No licenses are required. Licenses are required •
for all other installations
I.\Bwldmg\Permlts\ELC- PerrmtApp doc 04/03
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2005 -00158
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/17/2005
Phone: (503) 639 -4171 k �-Wp juy k
Inspection Requests (24,Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 3/21/2005 TIME: 7:10AM PAGE: 81
SITE ADDRESS: 09050 SW WASHINGTON SQUARE RD CLASS OF WORK:
SUBDIVISION: GEORGETOWN MANOR APT LOT #: TYPE OF USE:
PROJECT NAME: GEORGETOWN MANOR APARTMENTS
DESCRIPTION: Reconnect only.
OWNER: PRINCETON PROPERTY MGMT, PHONE #: 503-06-7674
CONTRACTOR: ' PHONE #:
Inspection Request Scheduled For: Date: 3/21 /2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
115 Electrical service/reconnect 002231 -01 503 -646 -7476 N
Corrections /Comments /Instructions:
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PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: / 7I. 4%(1�, Dater o / Phone #: (503) 718-