Permit C ITY IT OF TIGARD ELECTRICAL PERMIT
' PERMIT #: ELC2003 -00547
A 16'
DEVELOPMENT SERVICES DATE ISSUED: 9/2/03
13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171
PARCEL: 1S135DD-04300
SITE ADDRESS: 11850 SW GREENBURG RD
SUBDIVISION: ZONING: R 12
BLOCK: LOT : JURISDICTION: TIG
Project Description: Install 200amp. service /feeder and 12 branch circuits.
• 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: 12 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:
PATHFINDERS HOMES INC WILLAMETTE ELECTRIC INC
20055 SW PACIFIC HWY STE 105 PO BOX 230547
SHERWOOD, OR 97140 TIGARD, OR 97281
Phone: 503 - 625 -9151 Phone: 503 - 624 -3631
Reg #: LIC 75059
SUP 1965S
FEES ELE 34 -283C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 9/2/03 $160.10
[TAX] 8% State Tax 9/2/03 $12.81 Elect'I Service
Elect'I Final
Total $172.91
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: 6,4 (2 f/ d _,t1,0) Permit Signature: d v q 10_ _- L
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: / 9 h 6 5
Call 639 -4175 by 7:00pm for an inspection the next business day
•
Electrical Permit Application = FOR OF ; ISE °NIA' -
• _„ ��� Received
r ��' D atelBy: 9 `v2 � Permit Electrical No.��- C'.r�F,�J�j —DO 5.47( 7
City of Tigard R� Planni Ava Sign
Date/By: ng ppro
Permit No.:
13125 SW Hall Blvd. QQ Plan Review Other
Tigard, Oregon 97223
PG v Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: 503 -5ar.or.us 9 1 �� rrdi i'' I Case No.:
Post - Review Land Use
Internet: www.ci.tigard.or.us C!T "''
g �t 10.. A.,' r Date/By: Contac Juris.: ® See Page 2 for
24 -hour Inspection Request: 503 1 5V �' Name /Method: 77 _ Supplemental Information.
;,.,. .
. .�' .., . y
+ . ... _ , : TYPE =.OF WORK - :.'•?:� ;; , • s:����;r`:;'�° ��'t;, =, ' � � r.. ��' �y=, i. "� >PLAN�REVIEW:(Please' all that ... r �: ;
❑ New construction ❑ Demolition Cl Service over 225 amps- ❑ Health -care facility
commercial ❑ Ilazardous location
Addition/alteration/replacement ❑ Other: ❑ Service over 320 amps- rating of ❑ Building over 10,000 square feet,
':;?;''si;:`. ;'`i;''l ?' CATEGORY ;OF;CONS,TRL(QTION:': : :.i`#j .0,,'; ;± ;,',64'; 1 & 2 family dwellings four or more residential units in
E] 1 & 2- Family dwelling ❑ Commercial/Industrial ❑ System over 600 volts nominal one structure
❑ Building over three stories ❑ 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:
'''° ".'!'i ':`, ; •JOB SITE INFORMATIONOrcF OOATIOI!,I °'?rl K T o `f'i Submit sets of plans with any of the above.
The above are not applicable to temporary construction service.
Job site address: / / U s �� 'i" '`ai� t '' � � ��..:� l:,.., V , � t.; ;j ; ; :
S' G•J � z� +6t; ',a: �FEE��_SC1iEDUliE,a�:s. � .., «.. ?v'r' ��r',��;�,,�t: +.'tc�,•I ";;
Suite #: Bld.. /Apt. #: Number of inspections per permit allowed
Project Name: CI, ,,se 1— t(/ -e (( k- Description . Qty Fee (ea.) Total
Cross street/Directions to job site: New residential - single or multi - family per j
dwelling unit. Includes attached garage.
Service Included:
1000 sq. ft or less 145.15 4
Each additional 500 sq. ft. or portion thereof 33.40 I
Subdivision: ( Lot #: Limited energy, residential 75.00 2
Limited energy, non residential 75.00 2
Tax map /parcel #: Each manufactured home or modular dwelling
;'l ;'N:.; `,'ri• jly ` :,; ir:',a;D ESC tilPTION OF,.-iWO r i ` '' ;ice ,. ; '1r" service and/or feeder 90.90 2
Services or feeders - Installation,
R e w,,) eLe l alteration or relocation: fit:
200 amps or less l 80.30 .?I • 2
' 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
gG,jit. • O.' a1' ; i rowNER' .:: pm m j 601 amps to 1000 amps 240.60 2
] Over 1000 amps or volts 454.65 2
Name: CA t, i T (/.) 1
e i l.- Reconnect only 66.85 2
Address: zoo 5 S' S'cL) P -4 c t;'fwy /p \ ' Temporary services or feeders - installation,
alteration, or relocation:
City /State/Zip: •I, 5 y rnvJ 200 amps or less 66.85 I
Phone: Fax: 201 amps to 400 amps 100.30 2
®I PI.;Ib iN _ , i._,. GY.;, . <❑ CONr.. , ft$0.�. '' '�t;:�;
* . 401 to 600 amps 133.75 2
r � T�;,, ° "'. - ��C� Ip�. t *'' Branch circuits - new, alteration, or
Name: extension per panel:
A Fee for branch circuits with purchase of �� % G
Address:
service or feeder fee, each branch circuit I L. 6.65 7- 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: • , j . ,at Misc.(Service or feeder not included):
'' _" :, t ''' R il' `:, ::.CON -R r r' °. f '1 ' t ad+9t",'i li ry, Each pump or irrigation circle 53.40 2 •
Each sign or outline lighting 53.40 2
Job No: if ' Signal circuit(s) or a limited energy panel,
alteration, or extension Page 2 2
Business Name: W , ll A M e # e it e, r4 t r /, a • Description:
Address: Po 60, Z_30 s - i ?-
T t 5 n n CA Each additional inspection over the allowable in any of the above:
City /State /Zip:
9i Z k l Per inspection per hour (min. 1 hour) 62.50
Phone: 6 a, - 3 6 3 / Fax: 424 - .Z9 e- Investigation fee:
Other
CCB Lic. #: -2 , s-c , cc Lic. #: 3y - 26--3 L ,�• a ; r ; r� Nr " a
Supervising e lectrician ������� t �.xtv, ����"`�"`
p g Subtotal $ /` () , (Q
signature required: ,,� Q ,„_ Plan Review (25% of Permit Fee) $
Print :Name: 0 ri- ..• I (._ Lic : il 6 s State Surcharge (8% of Permit Fee) $ • 12,8 I
TOTAL PERMIT FEE $ / Z„ q/
Authorized Notice: This permit application expires if a permit is not obtained within
Signature: - Date: 180 days after It has been accepted as complete.
*Fee methodology set by Trl- County Building Industry Service Board.
' (Please print name) ,
'
i:\Dsts\Permit Forms\ElcPermitApp.doc 0 1/03
•
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:
El Audio and Stereo Systems
O Burglar Alarm
n Garage Door Opener
Heating, Ventilation and Air Conditioning System
Vacuum Systems
❑ 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
0 Boiler Controls
Clock Systems
▪ Data Telecommunication Installation
LI Fire Alarm Installation
HVAC
Instrumentation
Intercom and Paging Systems
n Landscape Irrigation Control* •
LI Medical
LI Nurse Calls
Outdoor Landscape Lighting
0 Protective Signaling
El Other
Number of Systems
* No licenses are required. Licenses are required for all •
other installations
•
i:\ Dsts\ PermitForms\ElcPermitAppPg 01 /03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171
MST
BUP
Received ` / :1/ P Date Request-d 2 7/ 0 /0 M PM BUP
Location I i •- ' - �.. 4. Suite MEC
Contact Person C.(2PJc-1-- eh( (Sv.3) 332-- fC ?El PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner
Footing / ELC
Foundation Access: / ("),
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: / SIT
Post & Beam ,!?YL Jtf CA J) ! GC
Shear Anchors 0 Q C�t ✓� (J
Ext Sheath/Shear T U
Int Sheath Shear
Framing
Insulation l :rt V4*
Drywall Nailing �/"
Firewall \ \ PAS 1,
Fire Sprinkler
Fire Alarm
Susp'd Ceiling 1
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 �1L ��\ r �' \'\) ) —' - o p 1r\ L D
PASS PART FAIL ���
MECHANICAL. \A
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL •
Service
' Rough -In
UG /Slab
Low Voltage
Fire Alarm
" PART FAIL El Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SITE El Please call for reinspection RE: E1 Unable to inspect — no access
Fire Supply Line
ADA
Approach /Sidewalk Date-5—
ate Inspe .< r / Ext
Other:
Final DO NOT REMOVE this inspection record f m the I site.
PASS PART FAIL