Permit 'CITY ELECTRICAL PERMIT
OF TIGARD
PERMIT #: ELC2005 -00172
rc�j DEVELOPMENT SERVICES DATE ISSUED: 3/22/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S115AD-00600
SITE ADDRESS: 16740 SW 108TH AVE ZONING: R - 4.5
SUBDIVISION: WILLOWBROOK FARM LOT : 030 JURISDICTION: TIG
Project Description: (4) branch circuits for kitchen finish.
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: 3 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:
MAY, MARTA PACIFIC NORTHWEST ELECTRIC INC
16740 SW 108TH AVE 16200 WIDMAN CT
TIGARD, OR 97224 OREGON CITY, OR 97045
Phone: 503 - 380 -1693 Phone: 503- 657 -1188
FEES Reg #: LIC 162893
ELE C6
Description Date Amount
[ELPRMT] ELC Permit 3/22/2005 $66.80
[TAX] 8% State Surcharge 3/22/2005 $5.34 REQUIRED ITEMS AND REPORTS
Total $72.14
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: /� Permittee Signature: 7
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.
Electri t_. ' :� i f '�O r --- y ? - -
Cal �e " _ - 1 ��, ;, : ; ; . •FOR OFFICE USE ONLY � .
City 16.73 VI Received U ' ' .. _ l
Of Tigard Date /By:,� 2 - 3 � Permit s o.:6( 5 )/ 7_
13125 SW Hall Blvd., Tigard, Q 9 W2 vv�w
l �' 2005 Plan Review
A
Phone: 503.639. 1171 Fax: 5 F fl�b I��1 Date /By: Other Permit:
Inspection Line: 503.639.4175 ' I Date Ready /By: tun :/ 8 See Page 2 for
Internet: www.ci.tigard.oell Tq (, p jj� Notified/Method: )" („7" Supplemental Information
B V 4 ThDTMNPU V !'11W N PLAN REVIEW
❑ New construction Addition /alteration/replacement Please check all that apply:
El Demolition ❑Other:
Service over 225 amps, comm'l ❑Hazardous location
['Service over 320 amps — rating EBuildn over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential
and 2 family dwelling ❑ Commercial /indu ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑Building over three stories ['Feeders, 400 amps or more
El Multi - family El Master builder 12 Other:
['Occupant load over 99 persons EManufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress /lighting plan RV park
Job no.: Job site address: 16 7 cto s tk le)? ❑Health -care facility ❑Other:
Submit 2 sets of plans with any of the above.
City/State /ZIP: -f- 3 � -,4 The above are not applicable to temporary construction service.
FEE* SCHEDULE
Suite /bldg. /apt. no.: . Project name: ..--114 Description I Qty. I 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'l 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
dwelling, service and/or feeder 90.90 2
� '� Cr Services or feeders installation, alteration, and /or relocation
Y ,-- G I W t S . p _fr ir-i , , > k k I , 200 amp or less 80.30 2
Tr 201 amps to 400 amps 106.85 2
PROPERTY OWNER ❑ TENANT 401 amps to 600 amps 160.60 2
Name: otp,_1 P44t u.( 601 amps to 1,000 amps 240.60 2
Address: , ? p'� .,w i ?•-•-‘, Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/State/ZIP: n ! t f /l f re/ ?op ,� Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) J ro -ig 5� . l Fax: ( ) 200 amps or less 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 ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each
Business name: 'p s -/+ t`C tju i , u�8r, �� � - C branch circuit
6.65
i
�+ B. Fee for branch circuits
Contact name: a'"._,Q without service or feeder fee,
each branch circuit 1 46.85 2
Address: )00 (ji--b M o +� - ,r1 . Each add'I branch circuit 3 6.65 2
City/State /ZIP: 0-4, C t - -- -y,L CO-- '- Miscellaneous (service or feeder not included)
` Pump or irrigation circle 53.40 2
Phone: ( ) Fax:: ( )
Signor outline lighting 53.40 2
E - mail: Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or
_ extension. Describe: Page 2 2
Business name: '� „L t �tr N O..., W-ese .c----cee,,,,-rei'7 , 4 - C .
Address: / t�a Wpb M
Each additional inspection over allowable in any of the above
GOPN C' ” Per inspection 62.50
City /State /ZIP: 0 5 o „,, C-, 7�( 0 2 C/7 r- Investigation per hour (I hr min) 62.50
/ C
Phone: ( 5' ) G 6 - { 8 0 J pp, Fax: ) ., (� 7a a'� d plant P Industrial lant er hour 73.75
� 1 ELECTRICAL PERMIT FEES*
I CCB Lie.: / 6�Q 93 Electrical Lic.: _ G 'I Suprv. Lic.: 9 S' Subtotal
'\ Suprv. Electrician signature, required: ■. C Plan review (25% of permit fee)
/ Print name: di , c ti- - • -.)-9- State surcharge (8% of permit fee) y .f y
TOTAL PERMIT FEE 7,2 ley
Authorized signature: ii. / This permit application expires if a permit is not obtained within ISO
CCC days after it has been accepted as complete
Print name: t. Date: * Fee methodology set by Tri -County Building Industry Service Board
** Number of inspections per permit allowed.
is ABuilding \Pcrnuts \ELC- PcmiitApp doe 12103 140 -4(1 sTi 1 0102 /CO.M/WEI3
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:
n Audio and Stereo Systems*
n Burglar Alarm
❑ Garage Door Opener*
I I Heating, Ventilation and Air Conditioning
System*
n Vacuum Systems*
n Other:
COMMERCIAL WORK ONLY:
Fee for each commercial system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
•
I I Audio and Stereo Systems
n Boiler Controls
n Clock Systems
n Data Telecommunication Installation
I I Fire Alarm Installation
❑ HVAC
•
n Instrumentation
n Intercom and Paging Systems
n Landscape Irrigation Control*
Medical
•
I I Nurse Calls
Outdoor Landscape Lighting*
n Protective Signaling
I I Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
\Build mg \Pemtit, \ELC- PennitApp doc 04/03
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2005 -00172
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/22/2005
Phone: (503) 639 -4171 :"opupliff
Inspection Requests (24 Hrs.): (503) 639 -4175 :.—..W
INSPECTION WORKSHEET FOR DATE: 3/25/2005 TIME: 7:07AM PAGE: 46
SITE ADDRESS: 16740 SW 108TH AVE CLASS OF WORK:
SUBDIVISION: WILLOWBROOK FARM LOT #: 030 TYPE OF USE:
1 PROJECT NAME: MAY
DESCRIPTION: (4) branch circuits for kitchen finish.
OWNER: MAY, MARTA, PHONE #: 503- 380 -1693
CONTRACTOR: PACIFIC NORTHWEST ELECTRIC INC PHONE #: 503.657 -1188
Inspection Request Scheduled For: Date: 3/25/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 002852 -01 503- 969 -8839 Y
Corrections /Comments/ Instructions:
I f
(... .
FA PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
n FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: g - +,� ^�7� Dater 1 .2--- U5 Phone #: (503) 718 -