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Permit
C ITY OF TIGARD ELECTRICAL PERMIT PERMIT #: ELC2004 -00794 DEVELOPMENT SERVICES DATE ISSUED: 12/13/2004 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 25111 BA -00100 SITE ADDRESS: 14196 SW 97TH AVE SUBDIVISION: ZONING: R BLOCK: LOT : JURISDICTION: TIG Project Description: Temporary power for new construction. RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS 1000 SF OR LESS: 0.00 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 FOR: 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: MASTERPIECE CONSTRUCTION INC GAGE ENTERPRISES INC 14225 SW 128TH PL PO BOX 1429 TIGARD, OR 97224 CLACKAMAS, OR 97015 -1429 Phone: 503 - 750 -5549 Phone: 503 - 657 -0142 Reg #: SUP 618s L1C 34544 FEES ELE 3 -128C Description Date Amount Required Inspections [ELPRMT] ELC Permit 12/13/200' $66.85 [TAX] 8% State Surcharge 12/13/200' $5.35 Elect'I Service Elect'I Final 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 a - : - o r R 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct clue- s to OUNC at (503) 246 :.99 o r 1-8 00 -332 -2 ■ Iss ed By: ( �'� f Permit Signature: y , 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 639 -4175 by 7:00pm for an inspection the next business day Electrical Permit Application 1( Hz O 1 11(1 l SE O\ 1.1 Received � Ci O Tigard Date/B . / n e) MN" Permit No.: t —� // dO7 Q A 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Phone: 503.639.4171 Fax: 503.598.1960 Date/B . Other Permit: Inspection Line: 503.639.4175 -1 'f I' Date ReadyBy: 1 //�� RI See Page 2 for Internet: www.ci.tigard.or.us Notified/Method: (t0 Supplemental Information TYPE OF WORK PLAN REVIEW .EFICIew construction ❑ Addition/alteration/replacement Please check all that apply: ❑ Demolition ❑Other: ❑Service over 225 amps, comm'I ❑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 ❑System over 600 volts nominal units in one structure ❑ Multi family ❑Master builder ❑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: / CI J ( l � S' �� daa � 1 -1 ., � (, �- ❑Health -care facility ❑der: ll 4 ! Submit 2 sets of plans with any of the above. City/State/ZIP: T (� ,/� k� O e7 ') 2.1 V The above are not applicable to temporary construction service. I' FEE* SCHEDULE / Suite/bldg. /apt. no.: Project name: / L( ( 4' ( rt✓ el ..?"."1-.... Des� � QtY_ I Fee' Tar •• Cross street/directions to job site: , ' 1 „ i 'V\ D O '"lit' c 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'I 500 sq. ft. or portion 33.40 1 Limited energy, residential 75.00 2 Tax map /parcel no.: Limited energy, non - residential 75.00 2 DESCRIPTION OF WORK Each manufactured or modular t , ` h ,/� e ( C r �` �� e ` dwelling, service and/or feeder 90.90 2 v I P I �' ) Services or feeders installation, alteration, and/or relocation 200 amps or less 80.30 2 PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2 ,p 401 amps to 600 amps 160.60 2 Name: On N` 1 " Py � 2 �� ( 1 601 amps to 1,000 amps 240.60 2 Address: ` ^ q 1 + Over 1,000 amps or volts 454.65 2 � —� , 51 .1 , 51 .1 1 / 1 1/ Reconnect only 66.85 2 t� City/State/ZIP: / - I �i( /Q K 'tom 2 2Y- Temporary services or feeders installation, alteration, and/or U Phone: ) -1 —c' (J Fax: 5'lj C ) 7,( -C� '3? / relocation � �� I �J S 200 amps or less / 66.85 44.16 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 ❑ CONTACT PERSON A. Fee for branch circuits with service or feeder fee, each 6.65 2 Business name: branch circuit B. Fee for branch circuits Contact name: without service or feeder fee, 46.85 2 Address: each branch circuit Each add'l branch circuit 6.65 2 City/State/ZIP: Miscellaneous (service or feeder not included) Pump or irrigation circle 53.40 2 Phone: ( ) f Fax: ( ) 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 natty • .. ' af. / � / � Address: �>. Each additional inspection over allowable in any of the above 4( Per inspection 62.50 City/State/ZIP: Investigation per hour (1 hr min) 62.50 Phone: ( ) I Fax: ( ) Industrial plant per hour 73.75 ELECTRICAL PERMIT FEES* _ CCB Lic.: Ele 'cal Lic.: Suprv. Lic.: .-- & 6.S Suprv. Electrician signature, required: Plan review (25% of permit fee) Print name: Date: State surcharge (8% of permit fee) 5.55 TOTAL PERMIT FEE 7 p.,„ 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- PamitApp.doc 12J03 440- 4615T(1t OZ/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 system $75.00 (SEE OAR 918 - 260 -260) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling ❑ Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations is\ Building \permits\FLC- PennitApp.doc 04/03 CITY OF TIGARD 24 -Hour BUILDING Inspectior,Line: (503) 639 -4175 INSPECTION DIVISION Business Line: (503) 639 -4171 MST BUP Received Date Requested /c — A AM PM BUP Location 1 (I 7 Suite MEC Contact Person — Ph ( ) '75 — 675L('/ PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC oN©U 'D 6 Footing Foundation ELC 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 c 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 E TRICAL e Rough=i n UG/Slab � Low Voltage ,v U e Alarm rte' Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. 'en PART FAIL SITE 111 Please call for reinspection RE: 111 Unable to inspect — no access Fire Supply Line ADA to; Approach/Sidewalk Date /J v Inspecto / . Ext Other: Final DO NOT REMOVE this inspection record rom e Job site. PASS PART FAIL