Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2005 -00086
g , ; �r�lln DEVELOPMENT SERVICES DATE ISSUED: 2/14/2005
13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171 PARCEL: 1S133AC -13100
SITE ADDRESS: 10960 SW HUNTINGTON AVE
SUBDIVISION: HAWK'S BEARD TOWNHOMES ZONING: R -25
BLOCK: LOT : 049 JURISDICTION: TIG
Project Description: Temporary electrical service for job shack.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: 1 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: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
DEREK L BROWN & ASSOC ELECTRUM INC
4949 SW MEADOWS RD DBA SPECTRUM ELECTRIC
LAKE OSWEGO, OR 97035 2050 VISTA AVE #100
SALEM, OR 97302
Phone: 503 - 866 -4897 Phone: 503 - 361 -1256
FEES Reg #: LIC 116453
SUP 2223S
Description Date Amount ELE 24 - 353C
[ELPRMT] ELC Permit 2/14/2005 $66.85
[TAX] 8% State Surcharge 2/14/2005 $5.35 REQUIRED ITEMS AND REPORTS
Total $72.20
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws.
All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is
susp - • 4- • o • • - • .n 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those
r - s are set forth in OAR • - 001 -00 0 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503)
6 -6699 or 1 -80* 332 -2344.
•
I - ued By: I / � d i rdid ei h nd Permit Signature:
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 639 -4175 by 7:00pm for an inspection the next business day
Electrical Permit Application FOR OFFICE USE ONLY
City of Tigard Da« ���
13125 SW Hall Blvd., Tigard, OR 97223 J �� ���
Plan Review
g
Phone: 503.639.4171 Fax: 503.598.1960
A � Date/B : Other Permit:
Inspection Line: 503.639.4175 . y► C '' I' Date Ready/By: /I'M, ; l21 See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: ((a Supplemental Information
ir
': ,.. `c , _ '.::r,, ' ,c t ,:.r = {. •to- :•.li ' A A RE
% .i•;
t^ ..- ; R?ORIC . . %� fi ■ •: • .. 1 t :r:::�F px == ..�,;.„ _ iy .,�.,... . _.t.,., _ .,.. , .. ,.- `4Y�' " •;.:,
El New construction ❑ Addition/alteration /replacement Please check all that apply:
❑ Demolition ❑ Other:
['Service over 225 amps, com'l ['Hazardous location
:. _ �;, , r . . ❑Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
' ' ,,
GAEGQ�tS <;OE ,:� - COIY$ -. . _ • a TCTI ti l: of 1- and 2- family dwellings 4 or more new residential
.• `-, • ;..: ; -: '': : .'.';` ,- ;' , ":• 7 •±,! _ -1- ..: - .:.......,i , ..t: .. :_ .. : = t : ::: ti-= : ,• � ;;fi .
❑ I- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building ['System over 600 volts nominal units in one structure
❑ Multi - family ❑Master builder ['Building over three stories ['Feeders, 400 amps or more
❑ Other:
❑Occupant load over 99 persons ['Manufactured structures or
.. �•: . I •, - ; ; JO B ' S IT E p? F O BMAT I; ON`, \I) L OCATION; _ . _,, - ['Egress/lighting plan RV park
a9 (QO e 140o- an id ,5v ❑Health -care facility ['Other:
Job no.: Job site address: 1
Submit 2 sets of plans with any of the above.
• City/State /ZIP: -r-‘ GA ?) cr 7 Z z 3 The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: Project name: pi /41rt91�s f3'EA : 'T`!. - ' ;'- : :1 .' , . r <ti `ate. . `. -:; D E`;'-'; ' `;r " . : -
D escription I Qty. I Fee. I Total
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
a, S Limited energy, non - residential 75.00 • 2
tD c .., Q I�, !,.:. RK "• • a Each manufactured or modular
Pe ' 4 � dwelling, service and /or feeder 90.90 2
C 0 aSTe.e c 11 "7 I I-E � - T E MAP. Pe c. ,�1 f E, 1----- Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
...: '::..: x - 201 amps to 400 amps 106.85 2
( FiOPERTY' OWNER / = = ...... 401 amps to 600 amps 160.60 2
Name: PER, L > L. if Rota) , A S$ c C . 601 amps to 1,000 amps 240.60 2 _
Address: 49 49 S •i) • M44•D& ?„t . Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/State/ZIP: . LA ICE OSWE GO Op.. 9 7 031) Temporary services or feeders installation, alteration, and/or
Phone: GO J) Zr06 p97 ( Fax: � 0 vV� So2 /...4244,c- 200 amps or less 66.85 V 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
2 APJLICAIT' • ` ' : -, .... •: I' C ONTACT' PERS6W,' 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)
Phone: ( ) Fax:: ( ) Pump or irrigation circle 53.40 2
Sign or outline lighting 53.40 2
E - mail: Signal circuit(s) or limited -
r_ , :: - ;,: = • ' , :; ' - ? _ : ..,,, : , :q .-,, 5: , energy panel, alteration, or
• : S ?E C Te,/ IV1 �, L E C TIa 1 �/ extension. Describe: Page 2 2
Business name: 1t `'
Address: IDO V I s1-4, AVM Each additional inspection over allowable in any of the above
3 Per inspection 62.50
City / State/ZIP: sA L otA I q' )3 04 Investigation per hour (1 hr min) 62.50
Phone: ( svJ _. 3W 1 42 Fax ( ) Industrial plant per hour 73.75
., .: ELEC'T,R1; ATi<PFRMi°G'F`E•FS*'- ;;;r:, °,:r?.`n3.'>
CCB Lic.: Electrical Lic.: Suprv. Lic.: Subtotal 6 4 , q S
Suprv. Electrician signature, required: Plan review (25% of permit fee)
Print name: Date: State surcharge (8% of permit fee) 5. 3 5
TOTAL PERMIT FEE -7 g•C7
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 \Pemtits\ELC- PermitApp.doc 12103 440.4615T(10 /02/CCM/WEB
Electrical Permit Application - City of Tigard .
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
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:
C. O1VIlvIER 'C'TAIV.OT{OI } >1r t
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
is \BuildingWemtiu\ELC- PcrmitApp.doc 04/03
Feb 14 05 03:38p Bruce Cone 503 - 521 -8465 p.l
02/14/2905 16:28 5633518810 SPECTRUM ELECTRIC PAGE 01
Feb 14 05 03:23p Brwoe Cone 503-521 -9465 p.
CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223 AcTIN DE
IMPORTANT PERMIT NOTICE
ELECTRUM INC
DBA SPECTRUM ELECTRIC
2050 VISTA AVE #100
SALEM, OR 97302
Electrical Signature Form
Permit #: ELC2005 -00086
Date Issued: 2/1412005
Parcel: 1 S133AC -13100
Site Address: 10960 SW HUNTINGTON AVE
Subdivision: HAWK'S BEARD TOWNHOMES
Block: Lot: 049
Jurisdiction: TIG •
Zoning: R.25
Remarks: Temporary electrical service for job shack.
Your company has bean 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. Please have the
appropriate individual from your company sign below and return this Electrical Signature Form prior to the
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:
DEREK L BROWN & ASSOC ELECTRUM INC
4949 SW MEADOWS RD DBA SPECTRUM ELECTRIC
LAKE OSWEGO, OR 97035 2050 VISTA AVE #100
SALEM, OR 97302
Phone #: 503 - 866 -4897 Phone #: 503- 361 -1256
Reg #: tiC 116453
SUP 2223S
ELE 24 -333C
AN INK SIGNATURE IS REQUIRED ON THIS FORM
Y. .1
Signature of Supervising Electrician
If you have any questions, please call 503.718.2433.
f -
-03 5 r 3
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested t AM .--- PM BUP
Location -� -_ - -L.. ,ii Suite MEC
Contact Person f 1./-l�C -� / Ph ( ) %' PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC c OOLS — )o 5
Footing
Foundation Access: ELC
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final C._ E
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
i - ln EL ECTRICAL � .. Q�' , "1
JSlab �
Low Voltage � pti
Fire Alarm
ART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SITE E Plea ll for reinspection RE: Unable to inspect — no access
Fire Supply Line _ c ,�
ADA c� ' / Q V
Approach/Sidewalk Date Inspector Ext
Other:
Final DO NOT REMOVE this Inspection record from th ob site.
PASS PART FAIL