Permit 5 / 6 'A Y ' � V l4 G z j i4bt l�"' �' ELECTRICAL PERMIT PERMIT #: ELC2003 -00146
DEVELOPMENT SERVICES DATE ISSUED: 3/19/03
,,��). 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S113AB-00800
SITE ADDRESS: 15995 SW 74TH AVE 150
SUBDIVISION: FANNO CREEK ACRE TRACTS ZONING: I -P
BLOCK: LOT : JURISDICTION: TIG
Project Description: Install 2 200amp feeders, 32 branch circuits, and 1 low voltage system Data /telecommunication.
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: 2 W /SERVICE OR FEEDER: 32 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:
DUNCAN, JOHN AAND DICKINSONS ELECTRIC
JANICE LEE 8449 SW BARBUR BLVD
7060 SW PALMER WAY PORTLAND, OR 97217
BEAVERTON, OR 97007
Phone: Phone: 246 -3550
Reg #: LIC 65534
SUP 3100S
FEES ELE 26 -140C
• Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 3/19/03 $448.40
[TAX] 8% State Tax 3/19/03 $35.88 Low Voltage Inspection
Elect'I Service
Total $484.28 Rough -in
Elect'I Final
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: .� Permit Signature:
OWNER INSTALLATION ONLY
The installatio i s ing 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:OOpm for an inspection the next business day
- CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2003 -00146
DEVELOPMENT SERVICES DATE ISSUED: 3/19/03
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
/ S ' 5 $ 14) 74I OA. .4; /5-0 PARCEL: 2S113AB -00800
SITE ADDRESS: && ' '''T " "
SUBDIVISION: FANNO CREEK ACRE TRACTS ZONING: I -P
BLOCK: LOT : JURISDICTION: TIG
Project Description: Install 2 200amp feeders, 32 branch circuits, and 1 low voltage system Data /telecommunication.
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/ SVCI FDR: 601 +amps - 1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: 2 W /SERVICE OR FEEDER: 32 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:
DUNCAN, JOHN AAND DICKINSONS ELECTRIC
JANICE LEE 8449 SW BARBUR BLVD
7060 SW PALMER WAY PORTLAND, OR 97217
BEAVERTON, OR 97007
Phone: Phone: 246 - 3550
Reg #: LIC 65534
SUP 3100S
FEES ELE 26 -140C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 3/19/03 $448.40
[TAX] 8% State Tax 3/19/03 $35.88 Low Voltage Inspection
Elect'I Service
Total $484.28 Rough -in
Elect'I Final
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 taw 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: Permit Signature: —i
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 IN TALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO: �X S
Call 639 -4175 by 7:OOpm for an inspection the next business day
Electrical Permit Application FOR OFFICE USE ONLY ' __
Received � Electrical '
/
_ Date/By: -0 -03 cPj l� Permit No.: ELC D00?)- 2 l'Y',1c,
City f Tigard Planning Approval Sign
y g Date /By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date /By: Permit No.:
Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post- Review Land Use
u�Hi(YI���" + Date /By: Case No.:
Internet: www.ci.tigard.or.us ■ � - l 11 Contact Juris.: ® See Page 2 for
24 -hour Inspection Request: 503- 639 - 4175 `"°'"-" ' Name /Method: Supplemental Information.
"..N ; .. .,.TYPE OF WORT ;IA � `. s M > gi l .., r::�
�r N. � �_, , r ,�,- PLAN�REVIEW (Please cbeckaall thaf���aPP1Ygin � .� -.
❑ New construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility
commercial ❑ Hazardous location
ddition/alteration/replacement ❑ Other: ❑ Service over 320 amps- rating of ❑ Building over 10,000 square feet,
`" t-; 4CATEGORY;OF CO , „ °NSTRUCTION ,. , ' 1 & 2 family dwellings four or more residential units in
❑ 1 & 2- Family dwelling 2<ommercial/Industrial ❑ System over 600 volts nominal one structure
❑ Building over three stories ❑ Feeders, 400 amps or more
❑ Accessory Building ❑ Multi- Family ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other:
f ';;VO.O.WW:0018ITVINtok114MIVINI andlLOTe TION I�%j Submit sets of plans with any of the above.
The above are not applicable to temporary construction service.
Job site address ;te , FEEE *ISCHEDULE , w , Aiz ',:', -., :: '_ '
Suite #: B1d . . /Apt. #: Number of inspections per permit allowed
Project Name: Description Qty Fee (ea.) Total 1
New residential - single or multi - family per
Cross street/Directions to job site: dwelling unit. Includes attached garage.
/-C/. S ` /� Service included:
1000 sq. ft. or less 145.15 4
Each additional 500 sq. ft. or portion thereof 33.40 1
Limited energy, residential 75.00 2
Subdivision: Lot #: Limited energy, non residential 75.00 2
Tax map /parcel #. Each manufactured home or modular dwelling
' ', C XM?a VHi DESCRIPTIONAOKWOKR1C :' ,. , i, . service and/or feeder 90.90 2
Services or feeders - installation,
alteration or relocation: „___
amps or less de du- Z 80.30 /U , (06 2
201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
t; sPROPERTY OWNER ) . �. 1. A ;; TENAN ; }. ` : ' "" 5 601 am to 1000 am 240.60 2
Over 1000 amps or volts 454.65 2
Name: Reconnect only 66.85 2
Address: Temporary services or feeders - installation,
alteration, or relocation:
City /State /Zip: 200 amps or less 66.85 1
Phone: Fax: 201 amps to 400 amps 100.30 2
401 to 600 amps 133.75 2
❑4- 00- 400 -1 ,t,.;a *.�r '. CONT 1` CT PE RSON ; Branch circuits - new, alteration, or
N ame: extension per panel:
A. Fee for branch circuits with purchase of 6.65 2
Address: service or feeder fee, each branch circuit
City /State /Zip: B. Fee for branch circuits without purchase of
service or feeder fee, first branch circuit 46.85 2
Phone: Fax: Each additional branch circuit 6.65 2
E-mail: Misc.(Service or feeder not included):
d „; Each pump or irrigation circle 53.40 2
A”; . ,. _< : „r.t : CONVTRAC`I'OR ry Il ,; , , :, 1'4` - . Each sign or outline lighting 53.40 2
Job No: '
Signal circuit(s) or a limited energy panel, - '7
alteration, or extension Page 2 / 7 2
Business Name: b � S � �L Description:
Address: 3qq % 5 �v& �6� R
Dl� 7 21 Each additional inspection over the allowable in any_ of the above:
City /State /Zip: I4 �� Per inspection per hour (min. 1 hour) _ 62.50
Phone: S%y -3Stf $ Fax: a / 3-69(1 9 Investigation fee: ,
CCB Lic. #: 6 ss 36( Lic. #: R - . o Other
01 , a.Z4gM it e =, . >.,,� ;„ i<
Supervising electrician _ Subtotal $ / /f /- Z. './ />
signature required: • 3 Plan Review (25% of Permit Fee) $
Print Name: / State Surc har e 8% of Permit Fee $ . j�
j � �V c✓� �ILu //t Lic. #: . -.. g ( ) :
`/ TOTAL PERMIT FEE $ Of Z}l
Authorized Notice: This permit application expires if a permit is not obtained within
Signature: Date: 180 days after it has been accepted as complete.
*Fee methodology set,by Tri- County Building Industry Service Board.
(Please print name)
is \Dsts\Permit Forms \ElcPermitApp.doc 01/03
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all systems $75.00
Check Type of Work Involved:
[1 Audio and Stereo Systems
F Burglar Alarm
Garage Door Opener
ri Heating, Ventilation and Air Conditioning System
n Vacuum Systems
fl Other
COMMERCIAL WORK ONLY:
Fee for each system $75.00
(SEE OAR 918 - 260 -260)
Check Type of Work Involved:
D Audio and Stereo Systems
El Boiler Controls
Clock Systems
Data Telecommunication Installation
D Fire Alarm Installation
n HVAC
n Instrumentation
n Intercom and Paging Systems
Landscape Irrigation Control
n Medical
I -1 Nurse Calls
ri Outdoor Landscape Lighting
• Protective Signaling
Other
Number of Systems
* No licenses are required. Licenses are required for all
other installations
i:\Dsts\Permit Forms\ElcPermitAppPg2.doc 01/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 - 4175
INSPECTfON DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested • �- • AM PM BUP
Location s q9 7 7 Suite /sd MEC
Contact Person Ph ( ) �l s ° ? ? PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner E/K.,, ELC
Footing ELC 3- C N f �' //-
Foundation Access:
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
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
ELECTRICAL
Service
Rough -In
UG /Slab
.env volt �1 �- , o/G t (9"wfrv/
Fire Alarm
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SS) PART FAIL
SITE ❑ Please call for reinspection RE: 0 Unable to inspect — no access
Fire Supply Line
/
Approach /Sidewalk Date --7 2 - insp.-
Other:
Final DO NOT REMOVE this inspection record fr i m the job e.
PASS PART FAIL
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
jaw
INSPECTION DIVISION Business Line: (503) 639 -4171 MST r� r�
BUP
Received Date Requested ' c r AM PM BUP
Location 1 � j 7z Suite 1 SZ MEC
Contact Person Ph ( ) PLM
Contractor Contractor r Ph ( ) L sa —0 4 /5e) SWR
BUILDING Tenant/Owner - � (1 «�� AP 3— °C
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath /Shear ' p �( ?
Framing i� ,`� �J c3) — ID �J VI
Insulation c
Drywall Nailing i !�l J _
Fi rewal I
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other: �-
Final
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
ART FAIL
''EXEC
ice
Rough -In
UG /Slab
Low Voltage L V. n 1 C V,f rs SOW 61,L
Fire Alarm
e tre> Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS S PART FA
SITE El Please call for reinspection RE: D Unable to inspect – no access
Fire Supply Line
ADA 1�- —
Approach /Sidewalk Dato✓ Inspector _
Other:
Final DO NOT REMOVE this inspection record om the jo site.
PASS PART FAIL
CITY OF TIQABO 24 -Hour
BUILDING R Inspection Line: (503) 639 -4175 .:
INSPECTION DIVISION Business Line: (503) 639 -4171 MST s.
,4,,194411,11 / BUP
Received Date Requested `7 AM PM BUP
Location /5 99,5 7V 4 ` - - Suite MEC
Contact Person Ph ( ) PLM
Contractor Ph ( ) 513 ° 2 ? Z 2 - SWR L'
BUILDING Tenant/Owner ELC t / 7 4.
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspe ' to - SIT
Post & Beam
Shear Anchors 1/0`12-d-
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler c.22
Fire Alarm
Susp'd Ceiling
Roof y '1A \ �� \�° c ,
Other: 1
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
4 ( . \ \\
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
ELECTRICAL
Service
• /Slab
Low Voltage
Fire Alarm
Fina Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PAS PART FAIL
SITE Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA 3-03 _.
Approach /Sidewalk Date Inspector EXt
Other: i
Final DO NOT REMOVE this inspecti s ecord ro e job site.
PASS PART FAIL