Permit a t; °� ELECTRICAL PERMIT
CITY OF T I GA R D
PERMIT #: ELC2005 -00714
DEVELOPMENT SERVICES DATE ISSUED: 9/26/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S105DA - 16400
SITE ADDRESS: 14565 SW KLIPSAN LN ZONING: R -
SUBDIVISION: PACIFIC CREST LOT : 052 JURISDICTION: TIG
Project Description: (1) inspection for concrete pour.
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: 1
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:
NICK WILSON OWNER
14565 SW KLIPSAN LN
TIGARD, OR 97223
Phone: 503 - 332 -3665 Phone:
FEES Reg #:
Description Date Amount
[ELPRMT] ELC Permit 9/26/2005 $62.50
[TAX] 8% State Surcharge 9/26/2005 $5.00 REQUIRED ITEMS AND REPORTS
Total $67.50
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws.
All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is
suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Orego Utility Notificati• n Center. Those
rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or .erect questions o • U C at
503 - 246 -6699 or 1-800334-2344.
Issued By: ; Permittee Signatu -: 4
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease,_or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
. SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project. •
Approved plans are required on the job site at the time of each inspection.
•
Electrical Permit Application : • , 'FOR oFI ICE USE O NIL , °
City of Tigard ����� Date/B . -,1 - Permit No.:� ,_ - I ` .
13125 SW Hall Blvd., Tigard, OR 9722REC Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 datti Received
iP;rir' I ��A Date /B . Other Permit:
Inspection Line: 503.639.4175 SEP 26 200-- U- Date Ready/By: NI El See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
' TYI F1 'OyO1$ARD • PLAN REVIEW
❑ New construction ❑ Adttitgontraito*Iiiginent Please check all that apply:
El Demolition they: 15c, N V I t✓� a F S I L V C.nVt� ❑Service over 225 amps, comm'l ❑Hazardous location
❑ Service over 320 amps - rating ['Bulldog over 10,000 sq. ft.,
. CATEGORY OF CONSTRUCTION . 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
El Multi- family El Master builderther: SP('< ❑Building over three stories ❑Feeders, 400 amps or more
❑Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION ' RV park
❑ EgressAighting p lan P
❑Health - care facility ❑Other:
Job no.: Job site address: A 5 - C /
� ` J _FW K L r -A NJ Submit 2 sets of plans with any of the above.
City / State/ZIP: / / G a , � The above are not applicable to temporary construction service.
FEE* SCHEDULE „
Suite/bldg. /apt. no.: Project name: kt/ /L.Pj j
Description 1 Qty. I Fee. I 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
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
/N G/ZO f/n/ 72 Ca lV Cl?vI dwelling, service and/or feeder 90.90 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
PROPER OWNER ❑ . TENANT 201 amps to 400 amps 106.85 2
” • 401 amps to 600 amps 160.60 2
Name: Ni C (Al/ / ca h) 601 amps to 1,000 amps 240.60 2
Address: j 4- 5— 1 -1,,, , Lie — r.l Z Over 1,000 amps or volts 454.65 2
Reconnect only • 66.85 2
City/State/ZIP: -- 77 , Q —2 —a—Z.3 Temporary services or feeders installation, alteration, and /or
( S ,3) '?7 — 3G S ( )
relocation amps Phone: U •'� Fax: 200 amps or less 66.85 1
Owner installation: This ins . Yon is bein • ad• e' property that I own which is not 201 amps to 400 amps 100.30 2
intended for sal lease, rent,,ii change , .r /to ORS 447, 449, 670, and 701. J 401 amps to 600 amps 133.75 2
Owner signature: ., ..A10A Date: 9 - 26 - " 6 5 Branch circuits — new, alteration, or extension, per panel
N.
' , . • ` O APPL ANT ❑ CONTACT PERSON A. Fee for branch circuits with
service or branch circuit
�der fee, each 6.65 2
Business name: bran
B. Fee for branch circuits
Contact name: n/ Cjt - k/ / (__S kJ without service or feeder fee, 46.85 2
Address: each branch circuit
S 'C Each add'l branch circuit 6.65 2
City/ State/ZIP: Miscellaneous (service or feeder not included)
Phone: ( ) F es:: ( ) Pump or irrigation circle 53.40 2
Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited-
„, .
' - CONTRACTOR . - .- , energy panel, alteration, or
extension. Describe: Page 2 2
Business name:
Address: Each additional inspection over allowable in any of the above
Per inspection , 62.50
City / State/ZIP: Investigation per hour (I hr min) 62.50
Phone: ( ) Fax: ( ) Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
CCB Lic.: Electrical Lic.: Suprv. Lic.: Subtotal
Suprv. Electrician signature, required: Plan review (25% of permit fee)
Print name: Date:
State surcharge (8 %of permit fee)
-- --
TOTAL PERMIT FEE
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 \Perrnits\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:
°RESIDENTIAL WORK ONLY:.,
Fee for all residential systems combined $75.00
Check Type of Work Involved:
El Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
El Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
❑ Other:
.C,ONIlVIERCIAL WORK'ONLY ^ 1
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
El Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
El Instrumentation
•
El Intercom and Paging Systems
El Landscape Irrigation Control*
El Medical
❑ Nurse Calls
El 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 04/03
L-
CIT?' )F TIGARD - , _ _
BUILDING DIVISION PERMIT #: L oo -a 714
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
2t�5
Phone: (503) 639- 4171u4pu�i,'�
Inspection Requests (24 Hrs.): (503) 639 -4175 '
INSPECTION WORKSHEET FOR DATE: 27/20Q5 TIME: 7 :0»AM PAGE:
SITE ADDRESS: 1Q565 KLIP 'AN CLASS OF WORK:
SUBDIVISION: PACIFIC CREST LOT #: 052 TYPE OF USE:
PROJECT NAME: WILSON
DESCRIPTION: (1) inspection for concrete pour.
OWNER: WILSON, NICK PHONE #: 503-33/3665
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 9127/200 J Pour Time:
Code # Inspection Description Confirm # Contact # Message
105 torrioundfs a. : er • 010656 -01 503- 332 -3665 Y
Corrections /. ommen - ructions: ) 2
. a/ t■-)L I 7 Cfn 1\,■1■TZ ,
•
-''. -a.PASS__ _ n PARTIAL APPROVAL _ _ _0 __CANCEL — _ ___ l_ NO_ ACCESS
._
FAIL I I r/J L FOR INSPECT 3 N n ADDITIONAL FEES ASSESSED
Inspector:
/ ./ Date: 1 iii Q7 Phone #: (503) 718- 2