Permit X
CITY OF TIGARD ELECTRICAL PERMIT
III ° PERMIT #: ELC2009-00079
° COMMUNITY DEVELOPMENT DATE ISSUED: 2/26/2009
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2 S 113AB -00300
SITE ADDRESS: 16037 SW UPP FERRY RD 175 ZONING: I -
SUBDIVISION: FAN CREEK EEK PLACE LOT : JURISDICTION: TIG
PROJECT: ZIP REALTY
Project Description: TI - (9) 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: 8 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:
OPUS NW TASKER ELECTRICAL CONSTRUCTION
1500 SW FIRST AVENUE #1100 39905 SE 37TH ST
PORTLAND, OR 97201 WASHOUGAL, WA 98671
Phone: 503 - 916 - 8963 Contact #: PRI 360 - 335 -8233
FAX 360 - 839 -0989
FEES
Description Date Amount Reg #: ELE C387
[ELPRMT] ELC Permit 2/26/2009 $100.05 LIC 180382
[TAX] 12% State Surchar 2/26/2009 $12.01 SUP 5020S
Total $112.06 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 . ::: - : . 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 an 180 days • q ENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center Those rules are set forth in
OA 952- 001 -0010 throug O' ' •5' -0' -0100. You may obtain copies of these rules or direct questions to OUNC at 503.246.6699 or 1.800.332 2344
Iss d By: I / .._ /� Permittee Signature: Y
4
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 INS LATION ONLY
SIGNATURE OF SUPR. ELEC'N: 1 '/ DATE: " 1 " -- /( 71/
LICENSE NO: 3 S
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.
electrical Permit Application ECEl Y L D FOR OFFICE USE ONLY
Received A/ D ' G +, A n 7 �
Date
City of Tigard Date/By /�[Y 1 Permit No • Cf-�-
lq 13125 SW Hall Blvd , Tigard, OR 97223 � Plan Review
C Phone 503 639 4171 Fax 503 598.196 tB 2 6 2009 Date/B• Other Permit
T I G A R D Inspection Line 503 639 4175 Date Ready /By Ions 0 See Page 2 for
Internet. www tigard-or gov CITY OF TIGARD Notified/Method. 1(t„ Supplemental Information
TYPE OF ItDIN(i DIVISION PLAN REVIEW
❑ 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 stones
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ I- 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 ", "I -2 ", "I -3 ",
Job no.: Job site address: . > IOOHP or more occupancy.
f 1 G, 9C or.'2_t • f ,C.' y / ❑ Six or more residential units ❑ Recreational vehicle parks
City/State /ZIP: ❑ Health-care facilities 0 Supply voltage for more than
�/C �� /� ❑ Hazardous locations 600 volts nominal
Suite/bldg. /apt. no.: Project name: /� ��/ ❑ Service or feeder 600 amps or more
p
L FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. I Total I •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq ft or less 145.15 4
Tax map /parcel no.: Ea add'I 500 sq ft. or portion 33 40 1
Limited energy, residential 75 00 2
DESCRIPTION OF WORK (with above sq ft )
/' Limited energy, multi- family 75 00 2
(
0 c i,eLiui f� lis r! / �/ if/ �/ J>¢ fro l residential (with above sq ft )
e
Services or feeders installation, alteration, and/or relocation
0 // /g- 7 1 S 200 amps or less 80 30 2
❑ PROPERTY OWNER l ❑ TENANT 201 amps to 400 amps 106 85 2
Name: 0 1.1,_5 y U �i J 401 amps to 600 amps 160 60 2
601 amps to 1,000 amps 240 60 2
Address: )SS 0 S4 /� i es I' I // e cp Over 1,000 amps or volts 454 65 2
City/State /ZIP: � �J � - /,//,:j 1 / 2 0 / Temporary services or feeders installation, alteration, and/or
z relocation
Phone: ( ) 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 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, per panel
Owner signature: Date: A Fee for branch circuits with
❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee, 6.65 2
�- each branch circuit
Business name: ,L B Fee for branch circuits ' 4/ 5.7
1 � �' without service or feeder fee,
Contact name:
�A /� / / c 2.. first branch circuit 46 85 2
Each add'I branch circuit 6 65 AstAr
Address: �d% DS ' J �� Miscellaneous (service or feeder not included)
City/State /ZIP: !)A.A j1it,P1ce Gam- / Each manufactured or modular
dwelling, service and/or feeder 90 90 2
Phone: C76 p) _RSV; 3 .? Fax: : (- 6' ) ..3 9, d9 s7, Reconnect only 6685 2
E -mail: Pump or irrigation circle 53 40 2
CONTRACTOR Sign or outline lighting 53 40 2
�y / Signal circuit(s) or limited -
Business name:
7/7/5-/ L S 72i Gs-, / l�0 /iii /-". energy panel, alteration, or
Address: // ,, �U � � l f rr 5 extension Describe Page 2
�C� 2
S
City/State /ZIP: 11. S AO , e,,,-;-", / A. 9' 2' 7 f Each additional inspection over allowable in any of the above
Per inspection 62 50
Phone: (3/pc) 3 , : .. 23:3. Fax: (.3p) 6 9 p <....- 6 9 Investigation per hour (I hr min) 62.50
CCB Lic.: /� Electrical Lie.: Suprv. Lie.: lndustnal plant per hour 73 75
�/�: S -� 3g 7 p rv. Sr)3. < ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: /
-� Subtotal / , v � Print name: 1 A j a / I/ AS� i L 2..2 �D Date: , Plan review (25 %of permit fee) '8 " �i State surcharge (12% of permit fee) 1 a
Authorized signature: TOTAL PERMIT FEE / / . CO
Print name: Date: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
• Number of inspections allowed per permit
I \Buddmg\Permits\ELC- PermitApp doc 05/23/06 440- 4615T(I1 /05 /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 $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
E l Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
El Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
El Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all' other installations
1 \Budding\Permrts\ELC- PermitApp doc 03/23/06
CITY Y OFTIGARD
BUILDING DIVISION PERMIT #:1 - Ki01 4^•0001
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 I � l
Inspection Requests (24 Hrs.): (503) 639 -4175 '_,.
INSPECTION WORKSHEET FOR DATE: 3 . ' '3 , D Ci TIME: PAGE:
SITE ADDRESS: 101" 1 6 W o rpiK, CLASS OF WORK:
SUBDIVISION: l LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: 3.11 .09 Pour Time:
Code # Inspection Description Confirm # Contact # Message
GE IL; _ CS cJ C+tom
4 f
orrections /Comments /Ins •
2 1' 3 f 2,M ct cr
S A ‘& IN 0 0w%.
( 1117C1
n J
•
rs PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: v Nb• Date: $43 ' or Phone #: (503) 718- 2,144
CITY OF TIGARD _ .
BUILDING DIVISION PERMIT #: f LC2009.O0079
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 73'2�tr2i)Q9
Phone: (503) 639 -4171 1, ���
Inspection Requests (24 Hrs.): (503) 639 -4175 .!+� '_..
INSPECTION WORKSHEET FOR DATE: 3/2/2009 TIME: 7 :OOAi'MM PAGE: 6
SITE ADDRESS: 10037 SW UPPER BOi, NES FERRY RD 175 CLASS OF WORK:
SUBDIVISION: E:ANNO CREEK PLACE LOT #: TYPE OF USE:
PROJECT NAME: ZIP REALTY'
DESCRIPTION: TI - (9) branch circuits,
. OWNER: OPUS NW, PHONE #: 60:4.91643963
CONTRACTOR: TASKER ELECTRICAL. CONSTRUCTION PHONE #: 360-33641233
Inspection Request Scheduled For: Date: 3/2/2009 Pour Time:
Code # Inspection Description Confirm # Contact # Message
196 Mk.c. inspection 080956- 01 350 -336- 8233 N
W' LL cav E,, .
Corrections /Comments/ Instructions:
VS Ftik.K i06 . o NOT e s t4M UN rgs5VIZ sag
ii 00 A
s - -> piotm-E WALL. CL a ! 1
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
f f F ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Gm. o yes " L Date: 3-2-9 Phone #: (503) 718- Z.L{Lj4
CITY OF TIGARD . .....::_-..
BUILDING DIVISION
A PERMIT #: FT.C2009.00079
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2126/2009
Phone: (503) 639-4171 Wil
Inspection Requests (24 Hrs.): (503) 639-4175 ,..-.44 d.
INSPECTION WORKSHEET FOR DATE: 2/27/2009 TIME: 7:01AM PAGE: 3
SITE ADDRESS: 16037 SW UPPER BOONES FERRY RD 175 CLASS OF WORK:
. 1
SUBDIVISION: FANNO CREEK PLACE LOT #: TYPE OF USE:
PROJECT NAME: ZIP REALTY
DESCRIPTION: 11 - (9) branch circuits.
OWNER: OPUS NW, PHONE #: 503-916-8963
CONTRACTOR: TASKER ELECTRICAL CONSTRUCTION PHONE #: :360-335-0233
Inspection Request Scheduled For: Date: 2127/2009 Pour Time:
Code # Inspection Description
( on y - Thm# Contact # Message
125 Wall cover 080910-01 360335-O233 N
Corrections /Comments/ Instructions:
<0 VAAK6 ..1f) A 1—.L_ Cr--fk.o Q .1 A N1:o p reajt:YZ
01 C/t,“.1 To Ttags■Alf•I i ok, 4■1 Ci--(t-5-.)0b l'‘),
. iNiNgT 6.\ g , ty tql..1. 240; .
d..
c.® LAp4A.4 .
i
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.
1
n PASS ■,/: -ARTIAL APPROVAL III CANCEL n NO ACCESS
0 FAIL 0 CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED
Inspector: Qi NO6 k-t Date: 2 ' 1 ;1 '1 . Phone #: (503) 718-