Permit C ITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00810
DEVELOPMENT SERVICES DATE ISSUED: 12/21/2004
,. ��I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2 S 115AA -01100
SITE ADDRESS: 16185 SW 108TH AVE
SUBDIVISION: WILLOWBROOK FARM ZONING: R
BLOCK: LOT : 027 JURISDICTION: TIG
Project Description: Feeder for temp. service.
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 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:
ELTON, MICHAEL D ELECTRUM INC
BY MDE INSTITUTIONAL DBA SPECTRUM ELECTRIC
6950 SW HAMPTON ST STE 320 2050 VISTA AVE #100
PORTLAND, OR 97223 SALEM, OR 97302
Phone: Phone: 503 - 361 - 1256
Reg #: LIC 116453
SUP 2223S
FEES ELE 24 -353C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 12/21/200 $65.85
[TAX] 8% State Surcharge 12/21/200 $5.27 Elect'I Service
Elect'I Final
Total $71.12
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: A P /,, Ali / t Permit Signature: A
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
I
Electrical PermitRE1GEtola
VED FOR OFFICE USE ONLY
C i t y [ Y f Tigard Date/By: /,, /‘ ` i . ✓1:3 Permit No. k fps/ .0
13125 SW Hall Blvd., Tigard, OR 97� 21 2004 Plan Review
Phone: 503.639.4171 Fax: 503.598. yy' �l A �i t Other Permit:
�IP' j Date y:
Inspection Line: 503.639.4175 _l . Date Ready/By: Jury 0 See Page 2 for
Internet: www.ci.tigard.or.uss CITY OF TIGA • b Notified/Method: / Li \ Supplemental Information
. B R , . i � PLAN REVIEW
.
-/ f New construction ❑ Addition/alteration/replacement Please check all that apply:
Demolition El Other: ❑Service over 225 amps, comm'l ❑Hazardous location
EService over 320 amps — rating ❑ Buildng over 10,000 sq. ft.,
;? 4 t> 72 4 t66-6*`I'42T4CII IY 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
OBuilding over three stories OFeeders, 400 amps or more
❑MuIti family C1 Master builder ❑ Other:
❑Occupant load over 99 persons ❑Manufactured structures or
.; �,,d" ...c m ai ..s .� .. ..:,, , - 1 ; ' All () f , . a x ❑Egress/lighting plan RV park
Job no.: I Job site address:/‘/K5' si /D5 TH , v J f ❑Health -care facility ['Other: :
Submit 2 sets of plans with any of the above.
City/State /ZIP: T� Ar^ The above are not applicable to temporary construction service.
/ ice . 4 ' TgV! SOH *DrEX'`
Suite/bldg. /apt. no.: 1 Project name: 1
name: /r... y f�.Ca✓� Description I Qty. Fee. Total 1 **
Cross street/directions to job site: Y New residential single- or multi - family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: I Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
:� .. V:i 44:1,, n .. fi. -Ya ,I . /..*, - T.p e, ' a ,,,i r,Is Ti a,,, .aX Each manufactured or modular
dwelling, service and /or feeder 90.90 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
. t ;n . "p, ', r 201 amps to 400 amps 106.85 2
' ' z i , '' ` .4' *' . " -' 401 amps to 600 amps 160.60 2
/J
Name: j V,•):7 � �� 4 601 amps to 1,000 amps 240.60 2
Address: ! Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/State /ZIP: Temporary services or feeders installation, alteration, and/or
Phone: ( ) I Fax: ( ) relocation
200 amps or less r ‘,::6-ix-g.. ) 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
•
G., t° l ' ,, U 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,
each branch circuit 46.85 2
Address: .. Each add'I branch circuit 6.65 2
City/State /ZIP: Miscellaneous (service or feeder not included)
Phone: ( ) Fax:: ( ) Pump or irrigation circle 53.40 2
Sign or outline lighting 53.40 2
E - mail: Signal circuit(s) or limited-
} `' t'-1 a g ' g ` energy panel, alteration, or
extension. Describe: Page 2 2
Business name:
PlGTiarm 1X-G
O f S ..e7760 Each additional inspection over allowable in any of the above
Address:
SU A...% // o ` e' Per inspection 62.50
City /State /ZIP: ` ___%G /j y2 .!:,/t 97Jo-2- Investigation per hour (1 hr min) 62.50
Phone: (.5D3 ) 3 — 93 Fax: (So3 ) 3G/ `J ' ' " Industrial plant per hour 73.75
CCB Lic.: //g %S 3 Electrical Lic.:,J3 - G Suprv. Lic ).3_ S Subtotal �s
Suprv. Electrician signature, required: '� ' � � � Plan review (25% of permit fee)
Print name /_ fq [5 x9��� Date:/ � G5/ State surcharge (8% of permit fee)
TOTAL PERMIT FEE 2/ /■2-
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 \Pernits\ELC- PermitApp, doc 12/03 440- 4615T(10 /02/COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
REST EI�I'1<IAL W ONLY
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
❑ A udio and Stereo Systems*
❑ B urglar Alarm
❑ G arage Door Opener*
❑ H eating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
❑ Other:
Fee for each commercial system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
❑ A udio 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*
❑ P rotective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
is\ Building \Pemuts\ELC- PermitApp.doc 04/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested / c' —' 8' AM PM BUP
Location / (o / 9,47 /0 8' J Suite MEC
Contact Person ►.c-t L— f-C Ph (_ ) , 30 3873 PLM
Contractor Ph (_ ) SWR
BUILDING Tenant/Owner ELC ‘74-06 Ev/ d
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
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
)44
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
' o ou ug h I n
UG/Slab
Low Voltage
,fire Alarm
Fins Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
0 Please call for reinspection RE: 0 Unable to inspect — no access
Fire Supply Line /
ADA Approach/Sidewalk Dat / � Inspe �� �Ae/ ` Ext
Other:
Final DO NOT REMOVE this inspection recor from t e job site.
PASS PART FAIL