Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2007 -00717
COMMUNITY DEVELOPMENT DATE ISSUED: 10/18/2007
416ARDI 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S 102C B -03400
SITE ADDRESS: 09820 SW FREWING ST 27 ZONING: R -12
SUBDIVISION: CHARLOTTENHOF APARTMENTS LOT : 009 JURISDICTION: TIG
PROJECT: CYPRESS CREST APARTMENTS
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: WISERVICE 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 OCC:
Owner: Contractor:
KENDRA CARLSON
9800 SW FREWING #33
TIGARD, OR 97223
Phone: 503 - 684 - 0624 Contact #:
FEES
Description Date Amount Reg #:
IELPRMT1 ELC Permit 10/18/200' $66.85
'TAX] 8% State Surcharge 10/18/200' $5.35
Total $72.20 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- ugh 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 y: I / /t.� /_L Permittee Signature: �- a • ■
NMI
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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i Ci of 'Tigard Date/By: /O 4S' O7 k J) Permit No.: F46 7/ 7
111 14 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
p L, Other Permit:
ti„ Phone: 503.639.4171 Fax: 503.598.1960 DateBy:
Inspection Line: 503.639.4175 Date Ready /By: 1u ® See Page 2 for
T I G A R ? Internet: www.tigard or.gov Notified/Method: ► t Supplemental Information
•
.TYPE OF WORK PLAN
❑ New construction ❑ Addition /alteration /replacement Please check all that apply (submit 2 sets of plans w /items 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 ' „ less 0 or
Commercial -use . agricultural
exceeds 10 000 amps at 150 volts o Floating buildings.
le s to ground, or exceeds 14,000 ❑ Comme - a is
❑ 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 ❑Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job no.: Job site address: 17 fl V� S-_trn' (� 100H or more. occueanonal vehicle parks.
occupancy.
T h �\Z 1 . 0 Six or more residential units. ❑ Recreatio
City/State /ZIP: 1 1 j71� Q - 1 ��] — J ❑ Haza Hazardous fcation ❑ Supply voltage for more than
+ 1 t1� ` 1 C� ❑Hazardous locations.
600 volts nominal.
Suite/bldg. /apt. no.: 2 Project name ❑ Service or feeder 600 amps or more.
T
(��-t ` 1L FEE SCHEDULE ` "
Cross street/directions to job site: � \C p 1`� �/) Description 1 Qty. 1 Fee. 1 Total
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 1 145.15 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.)
, 1 Limited energy, multi -family
`'° ' -x ^ -� 1 c '� I fl residential (with above sq. ft.) 75.00 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
' ❑ PROPERTY OW ❑ TENANT 201 amps to 400 amps 106.85 2
Name: V- . ( ' y j ( O v �' 401 amps to 600 amps 160.60 2
�ti v t 601 amps to 1,000 amps 240.60 2
Address: rtstO �W '1r Q 3\ 'S.-\- . Over 1,000 amps or volts 454.65 2
City/State /ZIP:'-"- Oa i Q Y - Temporary services or feeders installation, alteration, and/or
relocation
Phone: 4 a Q Z� Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that 1 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, er panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT - - 1 ❑ 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: ( ) Fax: : ( ) Reconnect only 1 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 -
energy panel, alteration, or
Address: extension. Describe: Page 2 2
City/State /ZIP: Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: ( ) Fax: ( ) Investigation per hour (1 hr min) 62.50
CCB Lic.: Electrical Lic.: Suprv. Lic.: Industrial plant per hour 73.75
ELECTRICAL" PERMIT • FEES ,
Suprv. Electrician signature, required: Subtotal:
Print name: Date: Plan review (25% of permit fee):
�} State surcharge (8% of permit fee):
Authorized signature :k / /Z TOTAL PERMIT FEE:
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.
I :\ Building \Permits\ELC- PermitApp.doc 05/23/06 440- 4615T(tt /05 /COWWEB
Electrical Permit Application - City of Tigard 1
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
: RESIDENTIAL WORK ONLY:
Fee for Al residential systems combined........ $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
n G • arage Door Opener*
•
n H eating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
is COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
n Audio and Stereo Systems
❑ Boiler Controls
n C lock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
n Instrumentation
❑ Intercom and Paging Systems
n Landscape Irrigation Control*
n 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
1: \BuildingWermits\ELC-PermitApp.doc 03/23/06
CITY OF TIGARD .
BUILDING DIVISION PERMIT #: E C2007- 00717
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/1012007
Phone: (503) 639 -4171 I,, it' J
Inspection Requests (24 Hrs.): (503) 639 -4175 , ' °� "���. L.
INSPECTION WORKSHEET FOR DATE: 10/19/2007 TIME: 7:01AM PAGE: 32
SITE ADDRESS: 09820 SW MEWING ST 27 CLASS OF WORK:
SUBDIVISION: CHARLOTTENHOF APARTMENTS LOT #: 009 TYPE OF USE:
PROJECT NAME: CYPRESS CREST APARTMENTS
DESCRIPTION: Reconnect only
OWNER: CARLSON, KENDRA PHONE #: 603.684- 0624
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: 10/19/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
1M Electrical service 0E ;7946-01 503684 -0624 N
Corrections /Comments/ Instructions:
../\)
A PASS I PARTIAL APPROVAL ❑ CANCEL NO ACCESS
FAIL I CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: G-- N eia L Date: 10 i fl Phone #: (503) 718- viii