Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2008 -00444
COMMUNITY DEVELOPMENT DATE ISSUED: 8/1/2008
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S 102BD -00701
SITE ADDRESS: 12785 SW PACIFIC HWY ZONING: C -G
SUBDIVISION: NO. TIGARDVILLE ADDITION AMEND LOT : 008 JURISDICTION: TIG
PROJECT: BURGERVILLE
Project Description: Installing temporary service.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: 1 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: 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:
CATHERINE BENNETH ALLIED ELECTRIC
C/O LAWRENCE K. PETERSON PO BOX 1640
8 NORTH STATE ST 301 NORTH PLAINS, OR 97133
LAKE OSWEGO, OR 97034
Phone: 503 - 635 -3546 Contact #: PRI 503 - 614 -8000
FAX 503 -614 -1186
FEES
Description Date Amount Reg #: ELE 34 -112C
[ELPRMT] ELC Permit 8/1/2008 $66.85 LIC 38538
[TAX] 12% State Surchar 8/1/2008 $8.02 SUP 3195S
Total $74.87 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 at 503.246.6699 or 1.800.332.2344.
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 Tigard tS) Re ceive d • v Q ( 05 Permit No.: j c - 2 &)d' -- nY1lf�y
° 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Q W `
_,,_ Phone: 503.639.4171 Fax: 503.5', S.71 coSO Date/By Other Permit: -caa
TIGARD Inspection Line: 503.639.4175 O� Date Ready /By• ® See Page 2 for
Internet: www.tigard- or.gov 111 Date
Notified/Method: Supplemental Information
' ..'. ," TYrE; OF *O - ' , . - ( % 14 - t0; - .:. f''. . ` ' ;PLAN4RE
New construction El Addition /alteratior�/�S\
Please check all that apply (submit 2 sets of plans w /items checked below):
114 ` ❑ Service or feeder 400 amps or more 0 Building over three stories.
E] Demolition El Other: V - ` ' , ' where the available fault current ❑Marinas and boatyards.
- • ' ' , .: CATEGORY -OF° CONS �' + TON exceeds 10,000 amps at 150 volts or ❑ Floating buildings. •
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ I- and 2- family dwelling Xi Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
MATION " system. larger separately derived sysem.
- _ -,.;,t .,,:° JOB._SITE : INFORMATION.-AND` LOCATION ` `.,, '
- - -" � - - - � new motor load of - 1-
A " Addition of
Job no.: Job site address: / ' 1 OOHP or more. occupancy.
It�� Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: 'I � � � 2 7 & s 5L') El Health-care facilities. ❑Supply voltage for more than
1 v � �� ❑Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: Project name: `I'�` _ �!_ _1 ❑ Service or feeder 600 amps or more.
`, ':: ' FEE SCHEDULE i ;`g . >- ;: -' ,e
Cross street/directions to job site: Description j Qty. i Fee. I Total I •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential
75.00 2
" , , .:; v , , DESCRIPTION" OF WORK . _,, < . " =': , ;" ',,,I.::',::' _ , (with above sq. ft.)
(RAO L W t ,� (� Limited energy, multi-family 75.00 2
t A C_, '( – (�Q f,{_ r,/ti�.Q residential (with above sq. ft.)
_ Y Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
w ® PROPERTY., OWNER,.".' ;: -' , • ,° ❑,; = '' ,' 201 amps to 400 amps 106.85 2
Name: 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City /State /ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) 200 amps or less i 66.85 06,6 1
- Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amp 100 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Branch circuits – new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
°' °'
" ' '''' ' :0--ICANT. , CONTAGT , -. above service or feeder fee,
� �.. ❑ • .APPL
each branch circuit 6.65 2
Business name: B. Fee for branch circuits
• Contact name: without service or feeder fee, 46.85 2
first branch circuit
Address: Each add'I branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City/State /ZIP: Each manufactured or modular
dwelling, service and /or feeder 90.90 2
Phone: ( ) Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
..,_,... _ _ .. , . - , . -- Sign or outline lighting 53.40 2
, ,, . , : •CONTRACTO: a , /" _ s.; _ . -' Business name: (� ) I E� l Signal panel, or limited-
v� �` �) energy panel, alteration, or
Address: �O°x, Vc40 extension. Describe: Page 2 2
City/State /ZIP: �/0 n p CAL_ R 7 / 3 7 Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: V t
( ) &d 61—R(/)?.) Fax: ( ) /4 Investigation per hour (1 hr min) 62.50
CCB Lic.: 5t3533 Electrical ' • • V Suprv. Lic.: j 5 Industrial plant per hour 73.75
% .'ELECTRICAL PERMIT FEES`. _
Suprv. Electrician signature, required Ca A - t tQ r , "` Subtotal: (
" Plan review (25% of permit fee)'
Print name:ecUp It (1. - / Date:
State surcharge (12% of permit fee): Z1 a4-
Authorized signature: TOTAL PERMIT FEE: _7C( y• 7
•
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
« Number of inspections allowed per pennit.
I:\Building\Permits\ELC -Perm itApp.doc 05/23/06 440 -461 ST( I1 /05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL, *()RK°ONI:Y.:. ;
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
Li Garage Door Opener*
n Heating, Ventilation and Air Conditioning System*
n Vacuum Systems*
n Other:
. COMMERCIAI: ",WORK; ONLY' ;7 ; N
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
n Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
n HVAC
❑ Instrumentation
n Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical _,
❑ Nurse Calls
n Outdoor Landscape Lighting*
n 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 03/23/06
I „ . •
CITY OF TIGARD
BUILDING DIVISION PERMIT #: 1
ELC200800444
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: afin.008
Phone: (503) 639-4171 Awiliptibtili
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 8m /2008 TIME: 7:03AM PAGE: i
SITE ADDRESS: 12785 SW PACIFIC HIArf CLASS OF WORK:
SUBDIVISION: NO - I IGARDVILLE ADDITION AMEND LOT #: 008 TYPE OF USE:
PROJECT NAME: BURGERVILLE
DESCRIPTION: Installing temporary service.
OWNER: BENNFTH, CATHERINE PHONE #: 503.835.35
CONTRACTOR: ALLIED !ELECTRIC PHONE #: 503-614-8000
Inspection Request Scheduled For: Date: 8/4/2008 Pour Time:
Code # Inspection Description -Q6lifirrn,# Contact # Message
110 Temporary electrical service 073683-01 503-781-1400 N
VA E-ksiAL___
Corrections/Comments/Instructions:
-
<5 -',' P..4„.. , ii0u- A 11 t, i , ti oN ' - • NS/ i lkii - ea.
1/41 1.40'44.- 1-ae
--,
_,...
c PARTIAL APPROVAL El CANCEL . NO ACCESS
FAIL fl CALL FOR INSPECTION El ADDITIONAL FEES ASSESSED
Inspector: G— 14 ea tt-- Date: et 4 - 09 Phone #: (503) 718- -liflik)