Permit CITY OF TIGAR® ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELC2008 00209
DATE ISSUED: 4/11/2008
T i G_n R D 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S112DD-00800
SITE ADDRESS: 15670 SW UPPER BOONES FERRY RD ZONING: C -G
SUBDIVISION: LOT : JURISDICTION: TIG
PROJECT: CHEVRON
Project Description: Installing (6) 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: SIGNAUPANEL:
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: 5 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:
FRED DRYSDALE INC. BOYLES ELECTRIC, INC.
PO BOX 757 P.O. BOX 1227
SHERWOOD, OR 97140 BORING, OR 97009
Phone: Contact #: PRI 503 - 668 -7440
FAX 503 - 668 -7615
FEES
Description Date Amount Reg #: ELE 3 -465C
[ELPRMT] ELC Permit 4/11/2008 $80.10 LIC 137002
[TAX] 12% State Surchar 4/11/2008 $9.61 SUP 34045
Total $89.71 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 -010g Ynu..may obtain copies of these rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
Issued By: �� / �r Permittee Signature:
l
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:
Cali 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.
007 10:45 FAX 5035981960 CITY OF TIGARD 01001
� _ _ 1C81 Permit Application
• FOR OFFICE LSE O Ll'
B •
City of Tigard vo / - Arm Permit No.: LC , ' 8'7)0 .
N ..
13125 SW Hall Blvd., Tigard, OR 97223 k°'9 Ptah Review
Phone: 503.639.4171 Fax: 503.598.1960 a • g Other Permit:
TIGARD Inspection Line: 503.639.4175 '� '1%(% Cofr Aeody/By' Ivrlt' See Pape z for
Internet: www.tigard -or.gov ' ° - Notified/Method: Supplemental Information
q e.
TYPE'OF' !ORI . >T s' . .za`� PLAN REYEW
❑ New construction 0 Addition /ate on(1+CO3` �A \ �c t, 1( r`'' Please cheek all that apply (submit g, sets of pima "dams checked below):
❑ Dttltolit;On Other. `; , , 0 Service or feeder 400 amps or more ❑ Building over three stories.
❑ ` where the available fault current ❑ Marinas and boatyautt
. '.`CATEGORY OF' CO Nt _ CflON exceeds 10.000 amps at 150 volts or 0 Floating buildings.
legs to ground, or exceeds 14.000 0 Commercial-use agricultural
❑ 1- and 2- family dwelling Commercial/industrial ❑ Accessory building amps for ail other installations_ buildings.
❑ Multi- family ] Master builder ❑ Other. ❑ Fire pump. 0 Installation of 13 KVA or
Emergency system. larger separately derived system.
-.. kat Sa'I'1r: INFORMATION ANA.:LOCATION . ' • '
... .. ... , ❑ Addvon ofaew motor load of p °n" °):,, "1-2" "I -3"
Job no.: Job site address: IS 1567o 60 cppt s Sys t or more. occupancy.
� ❑Six o r r tnow residential waits, 0 Recreational vehicle pules. .
City /State/P' LAKE- d std 6Cl D o 4 ( 1 035 ❑ Health facilities. ❑ Supply voltage for more than
0 Hazedous locations. 600 volts nominal.
Suite/bldglapt. Ito.: ' Project name: C. l �j . V/ o A v / 0 Servioc or feeder 600 amps or more
job site: FEE 'SCHEDULE y.
Cross street/directions to T
J » J oti. T Ph. 1 Told I •
New residential single- or multi- family dwelling unit
Inchndes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Tax map/parcel no.: Ea. add'l 500 sq. R. or portion 33.40 1
Limited energy. , resid ential 75.00 2
. DESC ITON .OF WORK..: ; (with above sq. IL)
Limited energy, multi- family 75.00 2
1.1 -0ZO/) LI-Cot Ri Li p e,.,2Ape residential (wit above sq. d.)
' Services or feeders Installation. alteration. an6J' relocadca
200 amps or less 80.30 2
. .. ❑. PROPER'LY`OWNER : .' ' ::.:
.....‘ : TEN'ANT - . ..:. :_: 201 amps to 400 amps 106.85 2
Name: /1 t o / _ cl 401 amps to 600 amps 160.60 2
L� IX r / 601 amps to 1,000 amps 240.60 2
Address: r V r3C»s 75-7 Over 1,000 amps or volts 454.65 2 .
City /State/ZIP: 5"2_ ru ,„ ,( v , q 7 Q,) Temporary services or feeders installation, alteration, and/or
r relocation
Phone: ( ) t 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 amp 10030 2 -
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 12
Branch circuits – new, alteration, or extension. per panel
Owner signature: _ Date:
A. Fcc for branch circuim with •
' ❑' APPLICANT ::.. :` .:: •. 0: COI 'ACT: PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: B. Fee for branch circuits 1� tt
without sexv;tx or feeder fee. I 46.85 1- 1(a.0 2
Contact name: first branch circuit
Address: Each add'I branch circuit rj 6.65 3 3.1,4' . 2
lT,seellaaeons (service or feeder not Included)
City /State/23P: Each manufactured or modular
dwelling. service and/or feeder 90.90 2
Phone: ( ) Fax:: ( ) Reconnect only I 66.85 2
E -mail: Pump or irrigation circle I 53.40 2
f . . .. . .' CONTRACTOR : - ... .. • Sign or outline lighting 53.40 2
Business name: p /� :/ G r t = Z,v energy p al er li or
' e � - . energy panel, alteration, or
Address: (:). %c y 1 -2_2:7 extension. Describe: Page 2 2
City/State /ZIP: s r ' -' d r 1700 ci : Each additional inspection over allowable in any of the above
r Per
Phone: ( 73) 005-7 V 0 I Fax ('3 ) (46 -74/ Investigation 62.50
' `l n per hour (1 hr min) 62.50
CCB Lie.: 13700 1 Electrical Lic.: , . y65 I Suprv. Lic.3 yO industital plant per hour 73.75
/ : • . . ' ELECTRICAL PERMIT FEE S
Suprv. Electrician signature, required: i Subtotal: 8(),10
Print name: 46 .. / , / Date: le OS Plan review (25% of permit fee):
State surchargeI a of permit fee): ci . (p 1
Authorized signature: • TOTAL PERMIT FEE: 81
Print name: Date: dm s p ermit application aspires r a permit b not obtained within 180
days after it has been accepted is complete.
• Number of inspections allowed per permit.
129,rildingk ink316LC-Perm*Upp.doc 05/23/06 4404615T(11/05/COMIWEa
CITY OF TIGARD
BUILDING DIVISION • PERMIT #: ELC20O3- 00209
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/11/200U
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 t.
INSPECTION WORKSHEET FOR DATE: 4/16/2008 TIME: 7:0OANi PAGE: 16
SITE ADDRESS: 15670 SW UPPER E3OONES FERRY RD CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: CHEVRON
DESCRIPTION: Installing (6) brancfrc:ircuits.
OWNER: FRED DRYSDALE INC., PHONE #:
CONTRACTOR: BOYLES ELECTRIC, INC. PHONE #: 503-663-7440
7440
Inspection Request Scheduled For: Date: 4/16/2008 Pour Time:
Code # Inspection Description Confirm Contact # ■sage
109 Electrical ctrical final 0613470 -01 503.663 -2628 Y
Corrections /Comments/ Instructions:
N
N \
PASS (l PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
1 Ntr- n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: GT ' 'vt Date: L{ 01 Phone #: (503) 718- .1-iftt•