Permit C ITY OF TI..G ARD ELECTRICAL PERMIT
VICES PERMIT #: EL 2 -00482
, �� DEVELOPMEN1. SE t DATE ISSUED: 8/2/2004
SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S101 DB 00201
SITE ADDRESS: 07582 SW HUNZIKER RD 047
SUBDIVISION: HILLCREST APARTMENTS ZONING. C -P
BLOCK: LOT : JURISDICTION: TIG
Project Description: Repair to meter base for unit #47.
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:
HNR REAL ESTATE LLC DICKINSONS ELECTRIC
7000 SW VARNS ST 8449 SW BARBUR BLVD
PORTLAND, OR 97223 PORTLAND, OR 97217
Phone: 503 - 670 -1555 Phone: 246 -3550
Reg #: LIC 65534 •
SUP 3100S
FEES ELE 26 -140C •
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 8/2/2004 $80.30
[TAX] 8% State Surcharge 8/2/2004 $6.42 Elect'l Service
Elect 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
suspende. • is ore than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those
rules - - set forth in •AR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503)
24s -6699 or 1 -800- 332 -23 , .
/ / Permit Si nature: T '
I-sued By: 1 , , 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
Electrical Permit Application I FOR OFFICE USE ONLY
City of Tigard t Date Received �� Permit No.: g Leda) r ft, 1 4
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 �" 71'4 j 'l I � R Date/13 : Other Permit:
Inspection Line: 503.639.41 ■, Date Read /B El See Page 2 for
P c —... ��I I Ready /By: g
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
...,r. .:� " : �, `�''" "� � �'� '�.' ;„ �"�a�s," == �'t� ":. �,. ;;,,���., >,^. '." ;;�,i�: .mar. w y $., :;,.
9 5 <t.> ;I ., ,, TYPE OF w�, ..1- % . r .F . :_ . „ . , - , • ' ^ ": PLAN _ REV.IE,W
�;iz" :.,,, „, - ,��. .. .r s s<. � ^ � �.�.,.��.� z.�a;,,�s:R =;... xax,�: r,��i,:i'�:s�a�°� �.:,,.... .. �. n�_�T . �,,. ,. .. .., . .. , „�.. - . R ... �. , _ "r`" _
❑ New construction ❑ Addition/alteration/replacement Please check all that apply _ . . -
:
❑ Demolition El Other: ['Service over 225 amps, comm'l Hazardous location
r ._ Service over 320 amps - rating EBuildng over 10,000 sq. ft.,
' I a ; CATEeORY QF' CONSTRUJC ION "�M "" 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
❑ Multi - family ❑Master builder ❑Other: ❑Building over three stories ❑Feeders, 400 amps or more
, �,. � r ❑Occupant load over 99 persons ['Manufactured structures or
mss 4 6 - , . JOB SIIP, INRO RMATIOPI .; ,,'' ' GAT ,. ' ki. ? ❑E gress /lighting plan RV.
Job no.: Job site address: 7 L S' 1u�y
['Health-care facility ❑Othe:
1 �� 91447 Submit 2 sets of plans with any of the above.
City /State /ZIP: T Cs✓M -- O 6 R The above are not applicable to temporary construction service
Suite/bldg. /apt. no.: Project name: Description Qty. Fee. Total
5 54 :;` =F -EE* " SCHEDULE': - ,;::` ** "
'� N ( A PT S • _
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
fi ,.. ,� � . BESCRIFTI0, �'VCRK °. ` .
_ �� . �;.. g am° �� .�.- ,,,.� . .--,- - �9., �. �� ��.�; x�� _ � �� ° Each manufactured or modular
�C f Art P la 1-1 E�,c C3 E-
dwelling, service and/or feeder 90.90 2
f R� � Services or feeders installation, alteration, and/or relocation
200 amps or less / 80.30 2
� ; ,.. ,. „ , • s „ H - w ` ; ; , , /,. $ mi - r ,: . . "' ", r ipz 201 amps to 400 amps 106.85 .2
_. PROP 6 ' .., ;, .�," , , ',- , ..1 ._ . . ® ; •a 1 ,..'
401 amps to 600 amps 160.60 2
Name: (L. v/ A(_ ( At A) g_ , c_ /4 r - Lt--,--) 601 amps to 1,000 amps 240.60 2
Address: - 1s - 82_ s 4v�Z-1 � ss...t- 441 Over 1,000 amps , or volts 454.65 2
City /State /ZIP: - T a (C. Temporary services or feeders installation, alteration, and /or
Phone: (b ) ( — t c s � 2000 0 amps Fax: ( )
relocation
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
" 0 g AiPPLIf i 'i° "3 ; ''' p'CO e RER S b ` is 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: ( ) F an: . : ( ) Pump or irrigation circle 53.40 2
Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited -
B ''r ° gON :RACT012" 1 :A .,,,' ' '�`'`_```' energy anel, alteration, or
; � , \ extension. Describe: Page 2 2
Business name: t ,' 4 / 1 d N gor
Address: Each additional inspection over allowable in any of the.above
Per inspection 62.50
City /State /ZIP: Investigation per hour (1 hr nun) 62.50
-
Phone: ( ) Fax: ( ) Industrial plant per hour 73.75
3 7 MII ET ECTRTC MIT' FEFsS *> ' - ' "'
CCB Lic.: Electrical Lic.: Suprv. Lic.: Subtotal i " g° ° 0
Suprv. Electrician signature, required: Plan review (25% of permit fee) 't r
��f
Print name: Date: State surcharge (8% of permit fee) - 7 - - `Y
TOTAL PERMIT FEE A
Authorized signature: This permit application expires if a permit is not obtained within 181(/(211
days after it has been accepted as complete Uur
Print name: Date: * Fee methodology set by Tri- County. Building Industry Service Board
** Number of inspections per permit allowed.
i:\Building\Permits\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:
a':$7. DE*: W,OR ONLY ;1 :. .,a , .3*B ,: M'
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:
Fee for each commercial system $75.00
(SEE OAR 918 - 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
El Landscape Irrigation Control* f)
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
is\ Building \Permits\ELC- PermitApp.doc 04/03
08/03/2004 07:25 5032136035 LARRY DICKINSON PAGE 01
08/02/2004 16:62 FAX 60359S1660. -°$ CITY OF TIGARD 21002
CITY OF T1ARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223 ` v°®
IMPORTANT PERMIT NOTICE p 3 tok
DICKINSONS ELECTRIC G`1 00 ks ON
8449 SW BARBUR BLVD B��1A�
PORTLAND, OR 97217
Electrical Signature Form
Permit #: ELC2004.00482
Date issued: 8/2/2004
Parcel: 2S101 D8.00201
Site Address: 07582 SW HUNZIKER RD 047
Subdivision; HILLCREST APARTMENTS
Block: Lot:
Jurisdiction: TIG
Zoning: C -P
Remarks: Repair to meter base for unit #47,
Your company has been indicated as the electrical contractor for the permit indicated above. lT order for
the electrical permit to be valid, the signature of the supervising electrician is required. Please have the
appropriate individual from your company sign below and return this Electrical Signature Form prior to the
start of the work to the address above, ATFN: Building Division.
No electrical inspections will be authorized until this completed form is received
OWNER: EL CONTRACTOR:
HNR REAL ESTATE LLC DICKINSONS ELECTRIC
7000 SW YARNS ST 8449 SW BARBUR BLVD
PORTLAND, OR 97223 PORTLAND, OR 97217
Phone #: 503 -670 -1555 Phone #: 246 -3550
Reg #: LIC 65534
sup 31003
ELE 26-140C
AN INK SIGNATURE IS REQUIRED ON THIS FORM
Signatur : . upe sing ElectriciOn
If you have any questions, please call 503.71 5.2433.
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTI N N Business Line: (503) 639 -4171 MST
BUP
Received 7 67 ' t ) 4 Olt? Requested 't fO 9 AM x PM BUP .
7,57P. > P
Location r.t Z l if Spa MEC
Contact Person t_C__- Ph ( 5) • '' D PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC 4__Og,_:LCV___4'
Footing
ELC
Foundation
Access:
Ftg Drain ELR
Crawl Drain - °
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath /Shear ,
Int Sheath /Shear
Framing
Insulation OPgav a_.- ,-62-J •
( Lf✓ i �-( x 4-r
Drywall Nailing 1 �
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 PART FAIL
Rough -I .
UG /Slab
Low Voltage
Fire , I: m
final ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
AL= PART FAIL
❑ Please call for reinspection RE: ❑ Unable to inspect - no access
Fire Supply Line
ADA Q )tt,vt I * jj�pf�t,/
Approach /Sidewalk Date C7 - 3 0 L( Inspector f l�i1/v `�'` Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL •