Permit CITY OF TIGARD ELECTRICAL PERMIT
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• T TIGARD #: ELC2006 -00053
��I II DEVELOPMENT SERiIICES DATE ISSUED: 1/25/2006
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 1S136CD-01401
SITE ADDRESS: 11652 SW PACIFIC HWY ZONING: C -G
SUBDIVISION: LOT : JURISDICTION: TIG
Project Description: (3) 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: 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: 2 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:
NMJ PROPERTIES LLC MARANATHA ELECTRICAL
9838 SW DAPPLEGREY LP CONSTRUCTION
BEAVERTON, OR 97008 9889 SE MATHER RD
CLACKAMAS, OR 97015
Phone: Contact #: PRI 503- 786 -2071
FAX 503 - 794 -6297
FEES
Description Date Amount Reg #: LIC 57428
[ELPRMT] ELC Permit 1/25/2006 $60.15 SUP 21725
[TAX] 8% State Surcharge 1/25/2006 $4.81 ELE 34 -65C
Total $64.96 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 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: _f_d Permittee Signature: _slt Q�,
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 A 1 •„ i s. n roil of rice ;sr ONLY
'C11ty of Tigard ' Received / :25 X71 Permit No.:6 e...44ZL"'( z) D - J
13125 SW Hall Blvd., Tigard, OR 97223 J A Plan Review
Phone: 503.639.4171 Fax 503.598.1960 /{ " Other Permit
2 - 20 ' �: � � Date/BV:
Inspection Ise: 503.639.4175 �_!„ Date Ready/By tuns: See Page 2 for
Internet' www.ci.tigard.or.us CITY op , Notified/Method: IV i I ® Supp l n f ormatlon
u T, 11Giili j
17 PLAN REVIEW
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❑ New construction Addition //alterahon/Pep N Please check all that apply:
❑ Demolition ❑Other ❑Service over 225 amps, comm'l ❑Hazardous location
• ❑ Service over 320 amps – rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential
❑ 1- and 2- family dwelling $1 Commercial/mdustrial ❑ Accessory building ❑ Stem over 600 volts nominal units in one structure
❑ Multi - family ❑ Master builder ❑ Other ❑Hurtling over three stories ❑Feedeas, 400 amps or more
❑Occupant load over 99 persons ['Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑E s/lighting plan RV park
•
1
Job no.: 3 Z 6 6 Job site address:1 S 7_ Q , ❑Healthcare facility ❑��
1 ' _ ° 4. L'Submit 2 sets of plans with any of the above.
City/State/ZIP: -'1" � r , � D q 2 2 3 ({t, The above are not applicable to temporary construction service.
/ nn Q FEE* SCHEDULE
Suite/bldg. /apt. no.: I Project name: e.ayiL L2JlY .i.4..� 4J� (2C u tko Qty. I Fee. I Total I .•
Cross street/directions to job site: &ay' r4--e...1" U New residential single- or multi-family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: I 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
DESCRIPTION OF WORK Each manufactured or modular
' dwelling, service and/or feeder - 90.90 - 2
Services or feeders installation, alteration, and/or relocation
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: 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) I Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I olvn %Niiich is not 201 amps to 400 amps 10030 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 6.65 2
Business name: branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee,
first branch circuit I 46.85 r S5 2
Address: Each add'l branch circuit 6.65
City/State/ZIP: Miscellaneous (service or feeder not included)
Phone: ( ) I Fax : ( ) 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
l Business name: M 61/44. c, h 0 ...... Z Imo \ (� extension. Describe: Page 2 2
R
Each additional inspection over allowable in any of the above
M Address: CI S Ci 5f_ 1Aa..,- Ro • C di �—
Per i on 6 2.50
City/State/ZIP:, K C N 0 .S O R 9 -7 b l 5 Investigation per hour (1 hr min) 62.50
k v) Phone: ( l '7 Industrial plant per boon I 73.75 +
" ! g� - Zd II - ( 563) 1q14_62.7-7 ELECTRICAL PERMIT FEFN - --
CCB Lic.: S rl Z $' I Electrical Lic - G5 i I . Lic • 2 1 ' J _ S Subtotal ' J p; %5
S uprv. Electrician signature, required: t° Plan review (25% of permit fee) i
Print name: C .* , / Date: 1 .. Z 5 - b State surcharge (8% of permit fee Y. �' l
TOTAL PERMIT FT
c f q J
/ AlItlfctrizv/l w I :1111 r This permit application expires lira permit is not : ... .
days after it has been accepted as complete
Print name' r 4'7 • Fee methodology sat by Tri- Coamty Building Iizdiistry Service Board
�� LL�L� -t. • -11 -...J
CITY OF TIGARD
BUILDING DIVISION PERMIT #:fac_20-0 OID
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 w ,,
Inspection Requests (24 Hrs.): (503) 639 -4175 .. yeti. —
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: 1i( Ac- ii----j7 CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: .— PHONE VI, W 30 -37 -g
CJ
CONTRACTOR: 0 PHONE
Inspection Request Scheduled For: Date: if I t --- Pour Time:
Code # Inspection Description Confirm # Contact # Message
195 R
Corrections /Comments/ Instructions:
( c.. i .- ...... r ' J
IA PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 1 V Date: • 4 'VO Phone #: (503) 718- LINO