Permit C ITY . OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2003 -00631
l l DEVELOPMENT SERVICES DATE ISSUED: 10/14/03
�' 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171
PARCEL: 1S135CD-08900
SITE ADDRESS: 11500 SW 98TH AVE
SUBDIVISION: PP1994 - 029 ZONING: R
BLOCK: LOT : 002 JURISDICTION: TIG
Project Description: Temporary power pole
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: 1 W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st WIO 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:
MIKE PARKER CONSTRUCTION ROSE ELECTRIC
16594 TIMBERLAND DR PO BOX 128
ALOHA, OR 97007 NORTH PLAINS, OR 97133
Phone: 503 -680 -0893 Phone: 503 - 648 -8254
Reg #: ELE 34 -130C
LIC 43084
FEES SUP 2767S
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 10/14/03 $80.30
[TAX] 8% State Tax 10/14/03 $6.42 Elect'I Service
Elect'l Final
Total $86.72
•
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 Utif Notifica 'on enter. Those rules are set
forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct . tions t (503) 246 -6699 or
1- 800 - 332 -2344.
Issued By: Pe rmit Signature: v
_
y I g
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
ctrical Permit A' lication FOR OFFICE USE ONLY
Received Electrical � /�'' ��'j
Date/By: Permit No.rt.t�., i
City Cit of Tigard Planning Approval Sign
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
/ /�mir'Niliry���k � � Date/By: Case No.:
Internet: www.ci.tigard.or.us • ; •1 I Contact Juris.: ® See Page 2 for
^
24 -hour Inspection Request: 503- 639 -4175 Name/Method: Supplemental Information.
❑ New construction • Demolition • Service over 225 amps- • Health -care facility
commercial ❑ Hazardous location
❑ Addition/alteration/re.lacement NI Other
❑ Service over 320 amps-rating of ❑ Building over 10,000 square feet,
t Q1__ ' = , '.', -y !; „ # „s : ,` i. 1 & 2 family dwellings four or more residential units in
❑ 1 & 2- Family dwelling ❑ Commercial/Industrial ❑ System over 600 volts nominal one structure
❑ Building over three stories ID 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:
1 ° - , g U9l . a T - Submit sets of plans with any of the above.
The above are not a. 1licable to tem.orar construction service.
Job site address: 0 a
� 15 0 S(U q s Y t ' � �.. e � � i � � ��.�. , ; a
Suite #: I Bldg./Apt.#: Number of inspections per permit allowed
Project Name: Description Qty Fee (ea.) Total
Cross street/Directions to job site: New residential- single or multi- family per 1
j dwelling unit. Includes attached garage.
1 ThL k I c / [ ` J� '� ^ t ! ^ C Q 2 Service included:
1000 sq. ft. or less 145.15 4
Each additional 500 sq. ft. or portion thereof 33.40 1
Subdivision: I Lot #: Limited energy, residential 75.00 2
Limited energy, non residential 75.00 2
Tax ma . / . arcel #: Each manufactured home or modular dwelling
, J : - service and/or feeder 90.90 2
Services or feeders - installation,
alteration or relocation: /53" ,
200 amps or less .:L 80.30 O' 2
201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
, k.�: 3 ,, : _ 601 amps to 1000 amps _ 240.60 2
Over 1000 amps or volts 454.65 2
�L 1"4,6,C.... _ 1fu Reconnect only 66.85 2
Address: (D �� # s� 46 p O r .' it ' Temporary services or feeders - installation,
alteration, or relocation:
City /State /Zip: AtOl 1-. '! 70 200 amps or less 66.85 1
Phone: & d'' 0 V13 Fax: & ? 2--- 201 amps to 400 amps 100.30 2
401 to 600 amps 133.75 2
' - i.;;; _ • ' - ` - - - _ Branch circuits - new, alteration, or
Name: M 1 - extension per panel:
Address: A . Fee for branch circuits with purchase of
service or feeder fee, each branch circuit 6.65 2
City /State /Zip: B. Fee for branch circuits without purchase of
service or feeder fee, first branch circuit 46.85 2
Phone: I Fax: Each additional branch circuit 6.65 2
E -mail: Misc.(Service or feeder not included):
�; Each pump or irri circle 53.40 2
Each si or outline li 53.40 2
Job No: Signal circuit(s) or a limited energy panel,
j� _ S � G alteration, or extension Page 2 2
Business Nape: r—U Description:
Address: 0 (ZS 1 o
Cit /State /Zi.: / 1 p Each additional inspection over the allowable in any of the above:
v V Per inspection per hour (min. 1 hour) 62.50
Phone: Fax: Investigation fee:
CCB Lic. #: 306 Lic. #: 3 t-_ 13o F o
Supervising electrician at' Subtotal $ p �
signature required: j Plan Review (25% of Permit Fee) $ 4 ` J
Print Name: , . tt,y O )� Lic. #: 2:7(47 5 State Surcharge (8% of Permit Fee) $ & "- f
1 TOTAL PERMIT FEE $ ' (' , la.,
Authorized Q Notice: This permit application expires if a permit is not obtained within
Signature: /V / G/ Date: t �� 180 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
(Please print name)
i:\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:
n Audio and Stereo Systems
0 Burglar Alarm
n Garage Door Opener
n Heating, Ventilation and Air Conditioning System
Vacuum Systems
n Other
COMMERCIAL WORK ONLY:
Fee for each system $75.00
(SEE OAR 918 - 260 -260)
Check Type of Work Involved:
n Audio and Stereo Systems
O Boiler Controls
O Clock Systems
O Data Telecommunication Installation
O Fire Alarm Installation
HVAC
n Instrumentation
O Intercom and Paging Systems
El Landscape Irrigation Control
El Medical
n Nurse Calls
n Outdoor Landscape Lighting
ri Protective Signaling
n Other
Number of Systems
* No licenses are required. Licenses are required for all
other installations
i: \Dsts\Permit Forms \ElcPemlitAppPg2.doc 01/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: 003) 639 -4175 MST
INSPECTION DIVISION Business Line: (503) 639 - 4171
BUP
Received Date Requested l " - 11 '3 AM PM BUP
Location k\ 0 D (` �, 0 Suite MEC
Contact Person �\ �� �' Ph g° `4) 8 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC '` D (o '�
Footing
Foundation Access: ELC
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 PAT FAIL
TRICA
C Sern
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
ICU PART FAIL
Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date / Q Inspect Ext
Other:
Final DO NOT REMOVE this inspection record from t ob site.
PASS PART FAIL