Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2008 -00080
COMMUNITY DEVELOPMENT DATE ISSUED: 2/13/2008
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 25111 CC -01800
SITE ADDRESS: 10315 SW CENTURY OAK DR ZONING: R -7
SUBDIVISION: SUMMERFIELD LOT: 015 JURISDICTION: TIG
PROJECT: GALLIEN
Project Description: Add ground rods.
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: 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:
ELWOOD GALLIEN DAY ELECTRIC LLC
10315 SW CENTURY OAK DR 21757 S LANCE CT
TIGARD, OR 97224 BEAVERCREEK, OR 97004
Phone: 503 - 624 -7079 Contact #: PRI 503 - 997 -1454
FAX 503 - 632 -3525
FEES
Description Date Amount Reg #: ELE 3 -552C
[ELPRM•1'] ELC Permit 2/13/2008 $46.85 LIC 153273
[TAX] 12% State Surchar 2/13/2008 $5.62 SUP 401 1 S
Total $52.47 REQUIRED ITEMS AND REPORTS
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 • ^ . eance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for
more th - 180 days. ATTE • ION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in
OAR 9;2- 001 -0010 through • • - • •2- 001 -0100. You may obtain copies of these rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
Issue, By: k_ / COW-4 Permittee Signat - At �J
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:
e •TRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: 41OP. i r � � � �GL'� -� 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 Application FOR OFFICE USE ONLY
Received p k p n /yq (,,"J'1
City of Tigard DDate/By: �� � e
8 Permit C� l/[.tJQV
" 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
II : Phone: 503.639.4171 Fax: 503.598.1960 DateBy: Other Permit.
T 16 A R D Inspection Line: 503.639.4175 Date Ready/By: Juris ® See Page 2 for
Internet: www.tigard - or.gov Notified/Method: / 6 Supplemental Information
TYPE OF WORK PLAN REVIEW
• ❑ New construction Addition alteration /replacement
Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more 0 Building over three stones.
❑ Demolition ❑ Other: where the available fault current ❑ Mannas and boatyards.
" ' CATEGORY OF CONSTRUCTION " . exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
)01- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
❑ Emergency system. larger separately derived system.
' , JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 - ",
y
Job no.: Job site address: � `` 100FIP or more. occupancy.
1 7 t �w Ce,' / / i/✓ t //L ❑ Six or more residential units. ❑ Recreational vehicle parks.
J
City/State /ZIP: / f� q / q ?2 2. ❑ Health -care facilities. ❑ Supply voltage for more than
/ ❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: / Project name: ❑ Service or feeder 600 amps or more.
' FEE SCHEDULE.
Cross street/directions to job site: Description I Qty. I Fee. I Total I •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'l 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
/
( �/ 1 /D+�Id- // A& Limited energy, multi- family 75.00 2
residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 8030 2
PROPERTY OWNER . ❑ TENANT 201 amps to 400 amps 106.85 2
Name: E / �.Cjl r 2 e 401 amps to 600 amps 160.60 2
L 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City/State /ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) 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 599 amps 133.75 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT CONTACT PERSON • above service or feeder fee, 6.65 2
each branch circuit
Business name: B. Fee for branch circuits
Contact name: 1-2_,, C � � � without service or feeder fee, 1 46.85 4 8S 2
C 7 fi rst b ranc h circuit
Address: Each add'l branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City/State /ZIP: Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Phone: ( $ &3) 88 r )-lob a- Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
/�/° Signal circuit(s) limited -
Business name: pet �5I p""� - `
energy panel, alteration, or
Address: .P., 1 S S te. c..+ �� extension. Describe: Page 2 2
City/State /ZIP: -f" c.I`2R 9, OCOLI Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: ( SAS ) 991 _ Fax: (g.ri) (03 &' 1523 Investigation per hour (1 hr min) 62.50
CCB Lie.: 1 S 3 2.2)3 Electrical Lie.: 3..g S a (. Suprv. Lie.: y b LS Industrial plant per hour 73.75
` * / / ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required:
d , J Subtotal: 2 , 5
Print name: ' ..X ; Date: 2 . /3 ,d Plan review (25% of permit fee): -{�'
� `^ z State surcharge (12% of permit fee): 5 (P9-
Authorized signature: TOTAL PERMIT FEE: 5 V
This permit application expires if a permit is not obtained wit in`186
Print•name: Date: days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\ Building \Permits\ELC- PermitApp.doc 05/23/06 440- 4615T(I I /05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information t�
LIMITED ENERGY PERMIT FEES:
rRESIDENTIALWOlR 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 $75.00
system
(SEE OAR 918- 309 -0000)
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*
n Medical
n Nurse Calls
❑' Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
•
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I:\ Building \Permits\ELC- PermitApp.doc. 03/23/06
CITY OF TIGARD
BUILDING DIVISION PERMIT #: FLC2000 -0008o
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2113/200;
Phone: (503) 639-4171
Requests (24 Hrs.): (503) 639- 4175±i' �..
INSPECTION WORKSHEET FOR DATE: 2/14/2008 TIME: 7:01AM PAGE:
SITE ADDRESS: 10315 SW CENTURY OAK DR CLASS OF WORK:
SUBDIVISION: SUI IMERFIELD LOT #: 016 TYPE OF USE:
PROJECT NAME: GALLIEN
DESCRIPTION: Add rn roads.
OWNER: GALLIEN, ELWOOD PHONE #: 503-624-7079
• CONTRACTOR: DAY ELECTRIC LI..0 PHONE #: 503. 837 -1454
Inspection Request Scheduled For: Date: 2/14/218 Pour Time:
Code # Inspection Description (_—Confir Contact # Message
'683' Electrical final 065052 -01 503-807-1002 N
Corrections /Comments /Instructions:
4 PASS) ❑ PARTIAL APPROVAL n CANCEL n NO ACCESS
n FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Gm N (% (_ Date: 1—' 6% Phone #: (503) 718- 1--4$0