Permit CITY OF TIGARD ELECTRICAL PERMIT
'+ PERMIT #: ELC2005 -00552
mall
DEVELOPMENT SERVICES DATE ISSUED: 8/3/2005
I 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2 S 102A6 -0360 0
SITE ADDRESS: 12271 SW MAIN ST ZONING: CBD
SUBDIVISION: LOT : JURISDICTION: TIG
Project Description: retrofitting 24 light fixtures w /new ballast and lamps on (2) 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: 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: 1 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:
JOHNSON, WARREN W + BETTY TRS AN PAUL ARNSBURG ADVANCE LIGHTING
JOHNSON, REES C + MARYANNE G 8818 SW SPRUCE ST.
3112 SW SANTA MONICA ST TIGARD, OR 97223
PORTLAND, OR 97201
Phone: Phone: 503 - 452 -0149
• FEES Reg #: LIC 93192
ELE 836LMS
Description Date Amount
[ELPRMT] ELC Permit 8/3/2005 $53.50
[TAX] 8% State Surcharge 8/3/2005 $4.28 REQUIRED ITEMS AND REPORTS
Total $57.78
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 1-11(-332-2
(-332 -2
Issued By: : _ _ _ Permittee Signature.
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 OFFICE USE ONLY
City of Y'iga ® r ,)/06, Permit No ! pD5 - -0d5L
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 .; ' ' 'r-. , �_,` i '• Date/By. Other Pe in&
Inspection Line: 503.639.4175 °1" co �'��� '�� '_�_� � Date ReadyBy. ' ho: ID See Page for
Internet: www.ci.tigard.or.us Notified/Method: J Supplemental Information
�
cq�
MM ON ON PLAN VIEW
El New construction U Addition/alteration/replacement ( Please check all that apply:
❑ Demolition Other: 3rd/ i� f5 ❑Service over 225 amps, comm'I ❑Hazardous location
DService over 320 amps — rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY dF CONSTRUCTION of 1 -and 2- family dwellings 4 or more new residential
❑ 1 - and 2- family dwelling Mommercial/industrial ❑ Accessory building 0 System over 600 volts nominal units in one structure
❑ Multi - family ❑Master builder ❑ Other: 0 Building over three stories 0 Feeders, 400 amps or more
❑Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION 0Egress/lighting plan RV park
' ❑Health - care facility DOther:
Job no.: Job site address: r 22-7/ Sw "VA-) Submit 2 sets of plans with any of the above.
City/State/ZIP: 7.4) at 17 ZZ3 The above are not applicable to temporary construction service.
Suite/bldg. /apt no.: 1 Project name: t)63 /) T/`i-e5s FEE* SCHEDULE
Description I Qty. I Fee. I Total
Cross street/directions to job site: ( jy / 1 / N ,B.,.c iA r t , 57 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'( 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
0 , t �� (� '� `� l/L /
4(3 141 / J5k fiF �;•,! - / A fi �/ . / dwelling, service and/or feeder _ 90.90 2
Services or feeders installation, alteration, and/or relocation
bel 4 O (Z) 0_,OZ..C<AltS 200 amps or less 80.30 2
❑ PROPERTY OWNER I TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: Mogc. f) - 5 601 amps to 1,000 amps 240.60 2
Address: r 7/1-) ( 50 fit/ ,t t- Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/State/ZIP: 11 6A-44 !L q
Q Temporary services or feeders installation, alteration, and/or
Phone: (55 3) es? -- Fax: ( ) relocation
v 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 I ❑ CONTACT PERSON A. Fee for branch circuits with
[ service or feeder fee, each
Business name: P./}✓L -44/gt .t /11)~ ' 05 t'14 , N branch circuit 6.65 2
Contact name: L 1gt$4. B. Fee for branch circuits
{� p without service or feeder fee, 46.85 2
V
Address: S ( e 540 (' p/U c each branch circuit /
Each add'I branch circuit / 6.65 2
City/State/ZIP: l . s41t-9 ` ot t 7 1.- z-3 Miscellaneous (service or feeder not Included)
Phone: ( 9'3) !f7 J � Q1 Fax: ( 5)) q( - - ',137 Pump or irrigation circle 53.40 2
l Sign or outline lighting 53.40 2
E - mail: (a-ti` C.i Ce5►K( sf , - rt./Cr Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or
extension. Describe: Page 2 2
Business name: I -e— fr5 ik 6111)
Address: Each additional inspection over allowable in any of the above
Per inspection 62.50
City/State/ZIP:
1 .‘' Investigation per hour (I hr min) 62.50
Phone: ( ) S (i(i 'l.� -7 I Fax: ( Industrial plant per hour 73.75
O ELECTRICAL PERMIT FEES*
CCB Lic.: ¶ 42 Electrical Lic.: 836C.4"5 1 Suprv. Lic.: •',' Subtotal 53 .► 5V
Suprv. Electrician signature, required: Plan review (25% of permit fee)
Print name: Date: State surcharge (8% of permit fee) 1, a8
TOTAL PERMIT FEE s'. -77
A uthorized sign ng, This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
. riot name: Date: • Fee methodology set by Tri- County Building Industry Service Board
•• Number of inspections per permit allowed.
i:\ Building \Permits\ELC- PnmitApp.doc 12/03 440- 4615T(10/07JCOM/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:
❑ 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 system. $75.00
(SEE OAR 91 8- 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ H VAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ M edical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ P rotective Signaling
❑ O ther
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
is Building \PetmitskELC- PemitApp.doc 04/03
R CITY OF TIGARD f
BUILDING DIVISION . PERMIT #: ELC2005 -00552
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/3/2005
Phone: (503) 639 - 4171 40 a'0yp�`
Inspection Requests (24 Hrs.): (503) 639 -4175 `__..
INSPECTION WORKSHEET FOR DATE: 8/6/2005 TIME: 7:02AM PAGE: 72
SITE ADDRESS: 12271 MAIN ST CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: NOBLE FIT SS
DESCRIPTION: retrofitting 24 I ht fixtures w /new ballast and lamps on (2) circuits.
OWNER: JOHNSON, WAR N W + BETTY TRS AN, PHONE #:
CONTRACTOR: PAUL ARNSBURG .DVANCE LIGHTING *11 . 3" 2-9 `7 PHONE #: 503 -452 -0149
Inspection Request Scheduled For: Date: 81512005 Pour Time:
Code # • • - - I - scription Confirm # Contact # Message
199 Electrical final 012857 -02 503-913 -2365 N
Corrections /Comme • '• •
E @ L) 6,17 .
iy0 ii\cES
C7-
\I A t\IN
lii PASS ❑ PARTIAL APPROVAL ❑ CANCEL NO ACCESS
►.4 FAIL • CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 1e N NQ La Date: 8(4(4_ Phone #: (503) 718--2-4%
i
CITY OF TIGARD ,�
BUILDING DIVISION PERMIT #: ELC2005 -00552
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/3/2005
Phone: (503) 639 -4171 A b,hr�"sljhl�
Inspection Requests (24 Hrs.): (503) 639 -4175 .�' °`__..
INSPECTION WORKSHEET FOR DATE: 8/4/2005 TIME: 7:08AM PAGE: 1
SITE ADDRESS: 12271 SW MAIN ST CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: NOBLE FITNESS
DESCRIPTION: retrofitting 24 light fixtures w /new ballast and lamps on (2) circuits.
OWNER: JOHNSON, WARREN W + BETTY TRS AN, PHONE #:
CONTRACTOR: PAUL ARNSBURG ADVANCE LIGHTING PHONE #: 503 -452 -0149
Inspection Request Scheduled For: Date: 81Q12005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
120 Electrical rough -in 012857 -01 503. 913-2365 N
Corrections /Comments /Instructions:
❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL "1"0 --- ACCESS
AIL h - , LL FOR INS' ECTION ❑ ADDITIONAL FEES ASSESSED
Inspector:
• � _ Date: - OS Phone #: (503) 718-