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Permit
C ITY OF TIGARD ELECTRICAL PERMIT PERMIT #: ELC2005 -00769 DEVELOPMENT SERVICES DATE ISSUED: 10/13/2005 hi 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 1 S135AA -AC001 SITE ADDRESS: 10390 SW 90TH AVE ZONING: R - 4.5 SUBDIVISION: ASHBROOK CONDOMINIUMS LOT : 001 JURISDICTION: TIG Project Description: Temp power for construction trailer located next to bldg. 4. RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS 1000 SF OR LESS: 0 - 200 amp: 1 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: 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: MATRIX DEVELOPMENT DMS ELECTRIC INC 12755 SW 69TH AVE, SUITE 100 8502 SE STARK ST TIGARD, OR 97223 PORTLAND, OR 9721 6 -6 61 1 Phone: 503 - 620 -2020 Phone: 503 - 209 -9298 • FEES Reg #: LIC .118073 tion Date Amount SUP 37 Description ELE 37 -742C [ELPRMT] ELC Permit 10/13/200` $66.85 [TAX] 8% State Surcharge 10/13/200` $5.35 REQUIRED ITEMS AND REPORTS Total $72.20 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 -80 32- 44. Issued By: ,,6,T 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. Electrical Permit A "li " x . I olt of ri'c (1SG n ,`GY ` , City of Tigard Received Date/B . /©% '0_3' 11 Permit No.: , i0 - ei a 13125 SW Hall Blvd., Tigard, OR 97223 OCT, 1 2 200 : Plan Review Phone: 503.639.4171 Fax: 503.598.1960 / '' " 8 ' - - -'' I °' Date /B . Other Permit Ern Inspection Line: 503.639.4175 '('�J 'j / . ' I -, Date Ready/By: El See Page 2 for Internet: www.ci.tigard.or.us �� 1 N ® � � 1 � `7 Notified/Method: Supplemental Information aW6TRPf`T 1 VISIO1' }�� PLAN REVIEW R'New construction ❑ Addition /alteration/replacement Please check all that apply: ❑ Demolition ❑Other: ❑Service over 225 amps, comm'l ❑Hazardous location ❑ Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft., CATEGORY OF CONSTRUCTION of 1 and 2 family dwellings 4 or more new residential ❑ 1 - and 2 family dwelling ❑ Commercial /industrial ❑ Accessory building 0 System over 600 volts nominal units in one structure al7Multi family El Master builder ID Other: ❑Building over three stories ❑Feeders, 400 amps or more ❑Occupant load over 99 persons ❑Manufactured structures or JOB SITE INFORMATION AND LOCATION ❑Egress/lighting plan RV park Job no.: Job site address: / o . 9� ,g ) 9f� C 0 Health-care facility ❑Other: • Submit 2 sets of plans with any of the above. • City/ State/ZIP: 7 ` ,i - Z The above are not applicable to temporary construction service. 4/ %uit• dg. :pt. no.: 17 Project name: A5i/ ( Y,4JDgfpifV /UJ,,. FEE* SCHEDULE . I Description I Qty. I Fee. I Total I • Cross street/directions to job site: %) fiI 0 1.-D r Ak New residential single- or multi- family dwelling unit. Includes attached garage. 1,000 sq. ft. or less 145.15 4 Subdivision�s0ook �rN %70/t //t//4-9.1-... Lot no.: Ea. add'I 500 sq. ft. or portion 33.40 1 Tax map /parcel no.: / 5 ' 5,14i � CC>o � Limited energy, residential 75.00 2 Limited energy, non - residential 75.00 2 DESCRIPTION OF WORK Each manufactured or modular dwelling, service and/or feeder 90.90 2 �E/:Ifs � C 4/42 Services or feeders installation, alteration, and /or relocation / 200 amps or less 80.30 2 .a. PROPERTY OWNER ❑ TENANT • 201 amps to 400 amps 106.85 2 401 amps to 600 amps 160.60 2 Name: /" A-7 - the D/= UE ? 601 amps to 1,000 amps 240.60 2 Address: /2 5 t,i ' � ) 69 - /t/e- S'vi /as Over 1,000 amps or volts 454.65 2 Reconnect only 66.85 2 City/State/ZIP: Oi<7 972-23 Temporary services or feeders installation, alteration, and /or relocation Phone: ( 503 62 _ 2020 Fax: ( ) 200 amps or less b 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 600 amps 133.75 2 Owner signature: • Date: Branch circuits - new, alteration, or extension, per panel ❑ APPLICANT ig CONTACT PERSON A. Fee for branch circuits with service or feeder fee, each 6.65 2 Business name: RC/ 1 i branch circuit e/1/70e/ B. Fee for branch circuits Contact name: j /-u /Z without service or feeder fee, each branch circuit 46.85 2 Address: Each add'I branch circuit 6.65 2 • Ci State/ZIP: Miscellaneous (service or feeder not included) Phone: (Sp - 9 - gee? Fax: : ( ) Pump or irrigation lighting 53.40 2 Sign or outline lighting 53.40 2 E - mail: Signal circuit(s) or limited- . CONTRACTOR energy panel, alteration, or extension. Describe: Page 2 2 Business name: D 5 ' C /e-G7x/e bVe Address: g g0Z SG � ,57' Each additional inspection over allowable in any of the above Per inspection 62.50 City / State/ZIP: / CO 972 f 6 — 6 6' /'7' Investigation per hour (1 hr min) 62.50 Phone: (331 2, .- 92c38 Fax: ( ) Industrial plant per hour 73.75 ELECTRICAL PERMIT FEES* • CCB Lic.: /4073 Electrical Lic.(3 - 71/2 . Suprv. Lic.: 1 /5t!? . S Subtotal t` Suprv. Electrician signature, required: Plan review (25% of permit fee) Print name: • Date: State surcharge (8% of permit fee) 5 3) TOTAL PERMIT FEE -7, .z 0 Authorized signature: This permit application expires if a permit is not obtained within 180 days after 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. i:\ Building \Permits\ELC- PermitApp doe 12/03 440-4615T(10/02/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* El Vacuum Systems* El Other: COMMERCIAL WORK .ONLYi . ' • • 1 Fee for each commercial system $75.00 (SEE OAR 918- 260 -260) Check Type of Work Involved: El Audio and Stereo Systems - El Boiler Controls ❑ Clock Systems El Data Telecommunication Installation El Fire Alarm Installation ❑ HVAC El I nstrumentation • El Intercom and Paging Systems El Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* El Protective Signaling El Other . Total number of commercial systems: *No licenses are required. Licenses are required for all other installations i'\ Building \Pennits\ELC- PetmitApp.doc 04/03 1.0/13/2005 08:46 FAX 5035981060 CI1'k OF TIGARD 0001 CITY OF TIGARD 13125 S.W. NALL BLVD. TIGARD, OR 97223 IMPORTANT PERMIT NOTICE VED DMS ELECTRIC INC 8502 SE STARK ST OCT 13 21/5 PORTLAND, OR 97216-6611 °F IVI Ol Electrical Signature Form BUILDING Permit #: ELC2005.00769 Date Issued: 10/13/2005 Parcel: 1 S135AA -ACo01 • Site Address; 10390 SW 90TH AVE 'Subdivision: ASHBROOK CONDOMINIUMS Block: Lot: 001 Jurisdiction: TIG Zoning: R4.5 Remarks: Temp power for construction trailer located next to bldg. 4. Your company has been Indicated as the electrical contractor for the permit indicated above. I n order for the electrical permit to be valid, the signature of the supervising electrician is required. Please have the appropriate individual from your company sign below and return this Electrical Signature Form prior to the start of the work to the address above, ATTN: Building Division, No electrical inspections will be authorized until this completed form Is received OWNER: ELECTRICAL CONTRACTOR: MATRIX DEVELOPMENT DMS ELECTRIC INC 12755 SW 6971-1 AVE, SUITE 100 8502 SE STARK ST TIGARD, OR 97223, PORTLAND, OR 97216 -6611 Phone #: 503 - 620_2020 Phone #: 603 - 2099298 Reg #: LIC 118073 • SUP 4542S ELE 37 -742C AN INK SIGNATURE IS REQUIRED 'O N THIS FORM Signature of Supervising Electrician If you have any questions, please call 503.718.2433. Ziti'd e96ti86S20S:o1 TTS92S220S DNI DM :10313 SWO:wo J 92 :2T S002- 2T -1DO CITY OF TIGARD `= S` BUILDING DIVISION PERMIT #: ELC200S -00769 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/13/2005 Phone: (503) 639 -4171 : f Inspection Requests (24 Hrs.): (503) 639 -4175 .� INSPECTION WORKSHEET FOR DATE: 10/28/2005 TIME: 7:18AM PAGE: 50 SITE ADDRESS: 10390 SW 90TH AVE CLASS OF WORK: �1 ' / SUBDIVISION: ASHBROOK CONDOMINIUMS LOT #: 001 TYPE OF USE: � PROJECT NAME: ASHBROOK CONDOMINIUMS C ± DESCRIPTION: Temp power for construction trailer located next to bldg. 4 OWNER: MATRIX DEVELOPMENT, PHONE #: 503 - 620 -2020 CONTRACTOR: DMS ELECTRIC INC PHONE #: 503.209 -9298 Inspection Request Scheduled For: Date: 10/28/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 110 Temporary electrical service 019706 -03 503-209-7386 N Corrections /Comments /Instructions: PA SS U PARTIAL APPROVAL , ❑ CANCEL I I NO ACCESS 1 I FAIL I I CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: .x:41 Date:/0 - 2e t r Phone #: (503) 718 - " r . 'C TIGARD ELC200S -00769 BUILDING DIVISION PERMIT #: 10/13/2005 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: Phone: (503) 639-4171 : 4Wryii,I�I Inspection Requests (24 Hrs.): (503) 639 -4175 .J_■ 10/24/2005 7:02AM 63 INSPECTION WORKSHEET FOR DATE: TIME: PAGE: 10390 SW 90TH AVE SITE ADDRESS: ASHBROOK CONDOMINIUMS 001 CLASS OF WORK: SUBDIVISION: ASHBROOK CONDOMINIUMS LOT #: TYPE OF USE: PROJECT NAME: Temp power for construction trailer located next to bldg. 4. DESCRIPTION: MATRIX DEVELOPMENT, 503- 620.2020 OWNER: DMS ELECTRIC INC PHONE #: 503- 209 -9298 CONTRACTOR: PHONE #: 10/24/2005 Inspection Request Scheduled For: Date: Pour Time: Cc # It se iggyEe eccrntati service u i j i t -01 f39-'966-'386 Me age Corrections /Comments /Instructions: 0 Vo p sZt` ,' o d-u-C1 Seru(e Cot Ad loo -�l No c cc i c<<r'e r �-0 CO � r4 '1 ( e /Uo e (e c t4 et Q_u 4.1\ lam/ I I PASS I I PARTIAL APPROVAL ❑ CANCEL �1 • ACCESS FAIL XALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: `,.1.44 Date: Phone #: (503) 718-