Permit 2006 /MAR /09 /THU 01:08 PM Conduit Electric FAX No, 5036923652 P.001
09/09/2008 12:05 FAX 5095981980 C ITY OF IraRn WilUU1 /UU1
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Building Division r. \I EP
,." �;�, Request for Permit Action or Rehr" .1
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TO: QTY OF TIGARD CITY O `i
Permit System Administrator isDIN(,T j)iA1)SI0
13125 SW Hall Blvd, Tigard, OR 97223
Phone: 503.718.2.430 Fax: 503J98.1960 www•tigard
FROM: ❑ Owner El Applicant 03 Contractor 0 City Staff
(duck ono)
Name: n 1
(Business oruavidual) l .nori t I. I T £ ' r dief (-, .
V 0 1 ® Mailing Address: I 11 _ . : • 71'
7j: XE N . City/Stale/Zip: - it 1 aSt c,t . (') e co9a5 970 6
Phone No.: _ 503 -Coca -1
PLEASE TAKE ACTION FOR THE ITEMS) CHECKED (✓)
►. CANCEL PERMIT APPLICATION.
IN REFUND PERMIT FEES. .
• REMOVE CONTRACTOR FROM PERMIT (do not cancel permit).
Permit 0: Vic, ado — f?L)(n 7 f_
Site Address or Parcel #: pt i '
it :t /114 b `
Project Name : . HS Tr di 51(19/
Subdivision Name: • Lot #:
EXPLANATION: 1.+ )►'n/'1 (vi )rrA fr a' h 5/ •
: zliglO 0
Print Name: Ue 0 pill WA rki r
_ U
L Th. Building OOda may authoriza+bc clued DE
e) any foe wbid warenuneouslY paid or collected. •
b) oot mere than B0 percent oft permit fee for lasted pa nits prior to any iospeetian reveals.
c) not ware than 80 percent ofplan review fee wbee as application Ise nceledbetote any plim rsviewv effortbos boon expeaded,
2. Refunds will be yenned to the original Payer in the snot method in which payment was received.
1. OR OFFICE 1 `,1. UNI_
Rte to S Admin: Date _ ourrowiror RmtoB1. • Mink: Date EriMi.
Date %Q" :air ��
Refund Processed: ; Invoice Procarsed: Date B . - Tag_A 7 dded Date �'
Permit Canceled: Date ' G = • - -
Receipt #C'_% Date Td ° • -•IT : CC _ Amount $ 5 ,7,-
MuildU stRe9PermitAC°on . - .. 01!20106
CITY OF TIGARD ELECTRICAL PERMIT
-� 1 PERMIT #: ELC2006 -00087
DEVELOPMENT SERVICES DATE ISSUED: 2/6/2006
■ °7 ' I � 13125 SW Hall Blvd., Tigard, OR 97223 503-639-4171
PARCEL: 25101 DD - 00701
SITE ADDRESS: 06960 SW SANDBURG ST ZONING: I -
SUBDIVISION: SALEM FREEWAY SUBDIVISION LOT : 004 JURISDICTION: TIG
Project Description: (4) 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: 3 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:
RFD PUBLICATIONS, INC CONDUIT ELECTRIC
9600 SW BOECKMAN DBA DUIT LEVEL TOOL CO
WILSONVILLE, OR 97070 19461 SW 89TH AVE
TUALATIN, OR 97062
Phone: Contact #: 'PRI 503 - 692 - 1428
FAX 503- 692 -3652
FEES
Description Date Amount Reg #: SUP 450IS
[ELPRMT] ELC Permit 2/6/2006 $53.50 LIC 109669
[TAX] 8% State Surcharge 2/6/2006 $4.28 ELE 26 -905C
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 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 questions to OUNC at 503 - 246 -6699 or
1- 800 - 332 -2344.
Issued By: 77 44 ,u>"' Permittee Signature: so c 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 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.
2006 /FEB /03 /FRI 03:55 PM Conduit Electric FAX No,5036923652 P. 001
. Electric Pe rmit A . lication . . FUR oFrl( :I use= ()NI 1
City of Tigard
it y.. 0 �-_ 11 6 %!� ; 1
13125 SW all Blvd., Tigard, OR. 9 -•• .. ' ' OtherPenad
Phone: 503.639.4171 Fax 503 - 59 'r`. ''..`•'1 ', '
Inspection Line: 503.639-4175 ��'�E ! - . I 1 ' 1 DateReady/9Y ® See Page 2for
-- 11oti Supplemental Information
Internet www.ci,tigartLor us ,
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' •xui:S�s'� ", «•. �. ! +u !s n i YC�' ,�,i t T n . -.,.3 .,, r� r1 � �` t X , - ;i t. . J l'. U> ,, ,.; ;:
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Ek� � -� � �. = -• � '• � V Please chat* all that apply ... ; v
- -
CI New construction ❑ : ■ , 'tion/alt�ion/replaceancnt
!� , OF TIGARD ❑Service over 225 amps, comet 1 ❑Hazardous loon
❑ Demolition � .. •;' ; ['Service over 320 amps - rating ❑Bulking over 10,000 sq. $.,
.a V ' ' c $ " ' ��� d 2-family dwellings 4 or snore new residential
Q^= rz 'a:,r_' :�'u�' '�= ,, o�:. �c�.` °:L' �� ,_. • x ^:' n�kl oft- ly n$S'
.1., 1...� -•, ,_ ''r (.- � :.-. .!!! :�hr0 ..i E,I,.. D .a• -'rj ,'r p�'}3`jc1'cf5cy�,•::.aa � ti' }`.o:.�.:tv�
:*� - �' =���_• 6.,-..,.. ^��� -�•��" ❑System over 600 volts nominal units in one structure l r s and 2- fierily dwelling ❑ Cozxtmcrcdail/tndttstrial ❑ Accessory building f Building aver three stories ['Feeders, 400 amps or more
❑ Marti- ,ily ❑ lvlastcr builder ❑ Other. ❑ Occupant load over 99 persona Maufac Dn r •
. ' - �' s. ,; - 1 tin V park etl structures or
„`5, :,, „z . .T r � : : ii u , 's i . F:� � ,.. i" 6 '1; t , t 4 ` ❑B�res9ll gh B Plan �
4n.,..a�o::n - ..'t ' �•i"-- s.ex�mac ` ❑Flealth -care Tactility
Job no -: /6 I , a Job site address. ,' d a ♦.. !. Su bmit /- sets of plans with any of the above. •
City/State/ZIP1` I The above are not applicable to temporary constuctien service.
Suite/bldglapt no.: ProjectnamerflL 1 14 S - n. ,,t, an Q. Fee Tisza "'
Cross street/directions to job site: New residential angle- or multi- family dwelling unit .
_Includes attached garage.
1,000 5. ft or less 145.15 4
I L o t no Ea. edd'l 500 al_ ft or portion 33.40 I
Subdivision: Limited energy, residential • 75.00 2
Tax map /parcel no.: • Limited energy, lion-residential 75.00 2
'.T, - .i'� - tit. }.,:N *
.Sec t/.� -,':' `°^' `° * 'sg.. -tsi,,:';x.1.}1,i " ;�j:- �-�5 . j a• r..r1. Each mmAnfactfn'ed or modular
'�VI^n_.Y.nr;. -': lr�_:i •�_c�•'�= .'a�or',.:i« J .;'x- 'SS':. Y: t..' r . i:.
dwelling, service and/or feeder :90.90 2
` L i I 41 O. - - Services or feeders installation, alteration, and/or relocation
• 200 amps or less 8030 2
*rr 7 201 to 400 amps 106.85 2
•r .�. .aP��? y iJ l.,.."rz?' -" ri �x.�"'F.;,r, �ur',? '� arms
� -caw, � : f �. `wa`= � � '�'t. f ' yr C. � ' � ` 7 •, z-f.
c) ✓ ZI PtL]�� c44 l !C•].�w V;i1- -• :' Cam. i�r e ft g .,�,L .7.-. 160.60 2
r, �r?�j .a.; ir- h�.� -=^ rc �s,: , .Fr: _� h.,. e.�-_ s 401 amps to 600 amps
Name: . . 601 amps to 1,000 amps 240.60 2
Over 1,000 amps or volts 454.65. . 2 , • Address: Rearnnect only . 66.115 . 2
City /State/ZIP: Temponnry services or feeders installation, alteration, and/or
relocapon
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 10030 2
intended for sale, least, 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
RVJ .� -_; , ) '
''' - C ".:7 r -�, M -[ -.. '• r" Aar A. Fee for brands circuits with
1. < - r 1 Y 1, � - L , ;. ; . . '• , ;, r. . �.,::,1 ...:.� 1: c' :. service or feeder fee, each 6 -65 • 2
Business name: ' branch circuit
B. Fee for branch circuits •
Contact name: wiihout service or feeder fee, 46.85 S5 2
each branch circuit ( ti iO
Address: Each add'l branch circuit 3 : 6.65 Lb rd. 2
City/State/ZIP: Miscellaneous (service or feeder not included)
ty PutoQ or irrigation circle 53.40 2
Phone: ( ) I Fax:: ( ) Sign or outline lighting 53-40 2
Signal circuit(s) or limited -
E - mail: _ _ ,:� ®' panel, alteration, or
C br. T' -_i 7+111'. .c ' t' - - ''• .1 . 7 , x i : n Wi t,•- r4 energy itr
4 i ti ..':. :i. r ,. e .; c� ` extension. Descr Page 2 2
Business name: Conch i / _I-(.4.4-i(_., ....
Each additional inspection over allowable taro any of the above
Address: I .9 s 4 , / '11 c A , ). Per inspection 62.50
City/State/ZW: / U an Iti n / se cl Q Investigation pet hour (1 br•min) .6250 .
Industrial plant per hour 7335
Phone: (S[).3) (v4) I • Fax: ' "r,, �7 1111 W0?)4ic ` , 7 a A 6 41VIAMPa V, .i1;; °':75'r. •
/ Electrical Lie.: a • . r v. L ie.: . Subtotal C
/ Pilate review (25% of permit fax)
Suprv. Electrician signature, required: � - e -
__ .
------- .•__ -• _ -- -. _. _ - ,,\\ .... /_..- _-- • --.... - . statesurcharge(8%ofpermitfee)
Print name: '� c5 . p r Date: a 3 V �.... TOTALFF>(tMIT FEE 51 7 '
Authorized signature: • This permit application expires if n permit is not obtained within 18o
days after it bas bees accepted as complete
Print name:
I Dom: • F methodolom' sea by Tri- Cosoty Building Industry Service Board
"• Number of iaspectiona per permit allowed.
i N&uldivnW mi . nitApp.doe 3 440.4615T(IO mrarMAVDa