Permit C ITY OF TIGARD ELECTRICAL PERMIT
K PERMIT #: ELC2005 -00190
DEVELOPMENT SERVICES DATE ISSUED: 3/30/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S101 BD 00101
SITE ADDRESS: 12805 SW 77TH PL ZONING: I -
SUBDIVISION: LOT : JURISDICTION: TIG
Project Description: Existing building. 1 branch circuit to welder.
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: IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amplvolt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
B R +G CO LLC NEW TECH ELECTRIC
PO BOX 23009 20811 NW CORNELL ROAD
TIGARD, OR 97223 HILLSBORO, OR 97124
Phone: Phone: 503 - 648 - 1900
FEES Reg #: LIC 41868
SUP 3849S
Description Date Amount ELE 26 - 418c
[TAX] 8% State Surcharge 3/30/2005 $3.75
[ELPRMT] ELC Permit 3/30/2005 $46.85 REQUIRED ITEMS AND REPORTS
Total $50.60
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws.
All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is
suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those
rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at
503 - 246 -6699 or 1- :e$ -33 -2344. /
Issued By: Alliks, z 4 Permittee Signature:
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.
03/30/05 WED 11:34 FAX 503 648 3131 NEW TECH ELEC al 001
Electrical Permit Application- F alt (*.Fla: USE ONLY
City of Tigard news J � pr Permit No.: „1405 2& /qq
13125 SW ];Tall Blvd., Tigard, OR 97223 P1anReview'
Phone: 503. 639.4171 Fax: 503.598.1960 � ,/i N it u 0 200 1 �� .,. "+F 1rr;,` Ii nate/B ! Other Permit
inspection Line: 503.639.4175 ' ! t:•11' Readyniy: EIE E1 See Page 2 for
Internet www.ci.tigard.or.us CITY OF TIGAnv NotifiedlMeLhod: Supplemental Information • ',.-.-.1 use is r.' llhtu �., u W+
... � rin
❑ New construction 0 Addition/alteration/replacement Please . check all that apply: •.
❑Service over 225 amps, cornet'1 DHazardous location
❑ Demolition ❑ Other:
Service
I! 11 ',li)i ut ' t C tt�i I >>pl0..'? � q kt (, • .. f- nd 2 family amps rating ❑ • dwellings p l m a over w residential
n t
tia
m
❑ i - and 2- fa dwe ❑ Comercial /ibdustrial ❑ Accessory building ❑S over 600 volts nominal units in one structure
❑Building over three stories ❑Feeders, 4.00 amps or more
❑ Mulh fatally ❑Master builder ❑ OtheT
❑ Occupant load over 99 p e st ructures rsons ❑Manufactured struc or
tans
' yea }I :i' :111!11[ i.o.If :)0. )0.0n Al t,tut:1' ; ( :�i;l:I1 ii :y`) e., :t;n:gs:a': ❑Egress /lighting plan RV park
r „ „.:.r...,:_.. i . ..._............ al[h care fa ❑Other.
Job no.: $ ( q Job site address: Z �5 S ['Health-care facility
ill
Submit sots of P with any of the above. •
City/State/ZIP: 7, c�� q 2. The above are not a PP licable to temporary construction service -
l I t11y't Jri 1 }h�l +l r J
, .i .. . �' t
Suite/bldg./apt, no.: Project name; , . e _ .■ 1 � _ .1,___....�
,
Il aer i puon • Qty. Fee. Total ".-
Cross street/directions to job site: New residential single- or multi - family dwelling unit
Includes attached garage.
1,000 sq- ft. or less 145.15 4
Subdivision: Lot no.: Ea. add'1500 sq. ft. or portion _ 33.40 1
Limited energy, residential 75.00 2
Tax maplptucel no Limited energy, non - residential 75.00 2
n d y Kr j lii." ol,'r;f 1t1�!'•;% . Bach manufactured ormodular
• 0 V 0- ■ k S
p a ( � � /; ; � S - , service and/or feeder 90.90 2
-.A...-1 � Il- :�� Services or feeders installation, alteration, and/or relocation
f
_ _ _ �,i� _ amps 8 0
1� ;;'mod lam; �� 4 �(� 200 amp or less 8
0.3 2
(61 ;111 d;i Fi , l ' l �i .�+ 6.67 i �, alt .
f .� amps to 400 amps 106.5 2
,.._ -. • , " . ,. , , . 5 - '_.1• ". ,I I - _ .. .aerie : .1 __ :.: I: .;.1 401 amps to 600 amps 160.60 2
Name: ,. Q h ` 1 601 amps to 1.000 amps 240.60 2 _
Address: - �W * 1 lac Over 1,000 amps or volts 454.65 2
Reconnect only 1 1 66.85 1 2
City/5tatc/ZIP: 1 Ck a , 0 t r Temporary services or Feeders installation, alteration, and/or
relocation
Phone: (503) b 0 _ 0 . Fax: ( StrV - 200 amps or less 66.85 1 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, rcpt, 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
..
W. /: .........!.'., . ..,,,. 1 , - -
,�. . . ,... ..:
.• .,"i '.{ , ���7 i ,4 �2 >��lir " Vlfi r %i'At F�pi���; � -
rr
. , lid c : -y . ),•. t , n a .p. • . ; a
k .., �:,:,*= �:,. a:...,: i.::,:•:.: �y. �,...,n . z_ .;� : .,�,,,.,,- d., ", : ,,. ;,. .. , : :, :.. .- .. :,,,,;.... : 1 service or feeder fee, each
Business name: �� branch circuit 6,G5 2
• B. Fee for branch circuits
Contact name: C / without service or feeder fee,
I each branch circuit ( 46.85 2
Address: ... b n • a Di Pseh add'1 branch circuit 6.65 2
City/State/ZIP: I-7 y e_ oiie.. - - T3 Miscellancoua (aervicc or feeder not included)
Pump or irrigation circle 53,40 2
Phone: ( ) Fax: = ( )
AL` Sign or outline lighting 53,40 2
E - mail: Signal circuit(s) or limited -
,.•., .,.,: : �. ... ; . ;, ,;,:. . ,.. :;;t alteration, ralion, or
rt• 81c 0 i i'b: a > .. dr'- tYi : :rl.o y panel, a
.� �.. .. :::.. a :2: y 'c. ..,�.,;: .. '1, .L.AI '�•-! :�Y._i J 4r�l�. , °.'t�G : ...... ..`;tw�. _ : ..... .__ _ r
V* :1'.."1. ,, " �_ . rr�... a__.. n.. a,_.,._ o.,, ,... :.,.....� _._a.�._ �. i �- _ :� .. _ � , - ,....,..L:: - .::_...1L. ' - energy
extension- Describe: Page 2 2
Business name: , . I r " t
Each additional inspection over allowable In any of the above
Address: r L :a. Per inspection 62.50
1 � • Investigation per hour (1 hr min) 62,50
Phone: (56 ) r Fax: (5:3 ) (t Industrial plant per hour 73.75 rn
: F=;- y .z., •e) al ¢ , � r . ,tl ?,l`M1 : {F ran :.
. . ' ` f , ' ^' L
UM 1 , �..J .,� :r,t. tr.�ie: �9P i:;lVai,.IJ:'l � 4e,t' (I 1, :a :uatA }: rr�s +t,r �'`.I.,ti'' a.�xi;J :l
r►� � Electrical Lie.: t Suprv. Lic_: - st{ Subtotal c
Suprv" Electrician signature, required: LL1 Plan review (25% of permit fee)
i. - -
\ Print name: ' lr'� 1 i IW� S,CA'N Dale: " S - ,c- Oc Stott surcharge (890 of permit fee)
TOTAL PERMIT FEE l 50 , 4
Authorized Signttttlre: This permit upplletaion expires If n permit is not trbtaincd within 180
days aver it has been accepted as complete
Print name: Date: • Fee methodology set by Tri- County Building Industry Service Board
'• Number of inspections per permit allowed.
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CITY OF TIGARD
BUILDINGIYI WSION PERMIT #: ELC2005 -00190
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/30/2005
Phone: (503) 639 -4171 Au�Oy��UI "f '
Inspection Requests (24 Hrs.): (503) 639 -4175
•
INSPECTION WORKSHEET FOR DATE: 4/6/2005 TIME: 7 :10AM PAGE: 211
SITE ADDRESS: 12805 SW 77TH PL CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: TEREX UTILITIES
DESCRIPTION: Existing building. 1 branch circuit to welder.
OWNER: B R + G CO LLC, PHONE #:
CONTRACTOR: NEW TECH ELECTRIC PHONE #: 503 -648 -1900
Inspection Request Scheduled For: Date: 4/6/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 003860 -01 503 - 849-1481 N
Corrections /Comments/ Instructions:
•
ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: � 6 , OS Phone #: (503) 718-