Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2003 -00429
4;4,11111' DEVELOPMENT SERVICES DATE ISSUED: 7/15/03
-- 13125 SW Hall Blvd.. Tigard. OR 97223 (503) 639 -4171
PARCEL: 2 S 103 D D -00900
SITE ADDRESS: 13855 SW PACIFIC HWY
SUBDIVISION: ZONING. C -G
BLOCK: LOT : JURISDICTION: TIG
Project Description: Relocate electrical meter for new construction.
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: 1 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:
COMMUNITY OF CHRIST MICHAEL DUFRESNE ELECTRIC
PO BOX 23462 9240 NE ST JOHNS AVE
•
TIGARD, OR 97281 PORTLAND, OR 97203
Phone: 503 - 684 -6620 Phone: 503 - 481 -8708
Reg #: LIC 148143
ELE 26- 1096CEP
FEES SUP 4794S
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 7/15/03 $106.85
[ELPRMT] ELC Permit 7/15/03 $8.55 Elect'l Service
Elect'l Final
Total $115.40
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 -2 /
Issue By: i) ' I , e 44 .! =' Permit 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 INSTAL TION ONLY
SIGNATURE OF SUPR. ELEC'N:n� r r1/ i4" « ` ° — � DATE:
LICENSE NO: 4 {79V5
Call 639 -4175 by 7:00pm for an inspection the next business day
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Elee ical Permit Application FOR OFFICE USE ONLY
Received 7M Electrical
Date/B : Permit No.: , _ , • -IV 7
• City of Tigard Planning Appro .1 ' J Sign
Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post-Review Land Use
: mtp � t� Date/By: Case No.:
Internet: www.ci.tigard.or.us ■ e l I Contact J : ,: ® See Page 2 for
^
24 -hour Inspection Request: 503- 639 -4175 -" - Name/Method: / a,. Supplemental Information.
TYPE OF WORK PLAN REVIEW (Please check all that apply) .
❑ New construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility
commercial ❑ Hazardous location
❑ Addition/alteration/replacement ❑ Other: ❑ Service over 320 amps- rating of ❑ Building over 10,000 square feet,
CATEGORY OF CONSTRUCTION I & 2 family dwellings four or more residential units in
❑ 1 & 2- Family dwelling ❑ Commercial/Industrial ❑ System over 600 volts nominal one structure
❑ Building over three stories ❑ Feeders, 400 amps or more
❑ Accessory Building ❑ Multi- Family ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other:
JOB SITE INFORMATION and LOCATION Submit _ sets of plans with any of the above.
_
` The above are not applicable to temporary construction service.
Job site address: Q j . C `nJ � ,(� }'�1r' l�J FEE* SCHEDULE
Suite #: I Bldg. /Apt. #: �J • Number of inspections per permit allowed
Pro'ect Name: ' ., k 1, 1.1 fa `. ' • • cri.tion Qty Fee (ea.) Total
- " v w desidential- single or multi - family per
Cross street/Directions to job site: dwelling unit. Includes attached garage.
Service included:
1000 sq. ft. or less 145.15 4
Each additional 500 sq. ft. or portion thereof 33.40 1
Subdivision: I Lot #: Limited energy, residential 75.00 2
Limited energy, non residential 75.00 2
Tax map /parcel #: Each manufactured home or modular dwelling
DESCRIPTION OF WORK service and/or feeder 90.90 2
Services or feeders - installation,
alteration or relocation:
200 amps or less _ 80.30 2
201 amps to 400 amps / 106.85 /pd,. SS 2
401 amps to 600 amps 160.60 ■ 2
❑'PROPERTY OWNER I ❑ TENANT 601 amps to 1000 amps 240.60 2
n > , Over 1000 amps or volts 454.65 2
Name: ('() 1)1 1. 1� 'M ce I , `, , 1. 1i, �r�'/ Reconnect only 66.85 2
Address: / q t-2 3 < iv c c 1 ) /' I ✓t / Temporary services or feeders - installation,
�u alteration, or relocation:
City /State /Zip: j l c y ./4 (D , Cj 9 1 200 amps or less 66.85
_ ++ ' 201 amps to 400 amps 100.30 2
Phone: (e,, ✓ q 4_ ?f3 Fax: 401 to 600 amps 133.75 2
❑ APPLICAN ❑ CONTACT PERSON Branch circuits - new, alteration, or
Name: extension per panel:
A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 6.65 2
City /State /Zip: B. Fee for branch circuits without purchase of
service or feeder fee, first branch circuit 46.85 2
Phone: I Fax: Each additional branch circuit 6.65 2
E -mail: Misc.(Service or feeder not included):
CONTR Each pump or irrigation circle 53.40 2
. Each sign or outline lighting 53.40 2
Job No: Signal circuit(s) or a limited energy panel,
alteration, or extension Page 2 2
Business Name: ?AAA-4 «�� 1,° e -t2 . E) (4 (Description:
Address: g e /v , Sr_ 1. (74 p �O�v ('>
Each additional inspection over the allowable in any of the above:
City /State /Zip: t l ni l,, y - 00,9 ° Per inspection per hour (min. 1 hour) 62.50
! � Investigation fee:
Phone:c — I r? Fax: _ Other:
CCB Lic. #: f' f ` Lic. *OM 9 Electrical Permit Fees*- ' T=
Supervising electrician _ Subtotal $ /D(v • 8 �
signature required: , ck 4,4a Plan Review (25% of Permit Fee) $ ,
Print Name: �' � I Lid. #: '� �' State Surcharge (8% of Permit Fee) $ g :55 /f r ) �' �t`{� — TOTAL PERMIT FEE $ -/5 , qo/
Authorized Notice: This permit application expires if a permit is not ootaIuv......hin
Signature: Date: 180 days after it has been accepted as complete.
*Fee methodology set. by Tri -County Building Industry Service Board.
(Please print name)
i:\Dsts\Permit Forms \ElcPermitApp.doc 01/03
Electrical Permit Application - City of Tigard ,"_
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all systems $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems
Burglar Alarm
❑ Garage Door Opener
n Heating, Ventilation and Air Conditioning System
Vacuum Systems
❑ Other
COMMERCIAL WORK ONLY:
Fee for each system $75.00
(SEE OAR 918- 260 -260) •
Check Type of Work Involved:
❑ Audio and Stereo Systems
c . Boiler Controls
I Clock Systems
Data Telecommunication Installation
0 Fire Alarm Installation
HVAC
Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control
0 Medical
Nurse Calls
Outdoor Landscape Lighting
Protective Signaling
n Other ■
Number of Systems
*'No licenses are required. Licenses are required for all
. other installations
•
i:\Dsts\Perrnit Forms \ElcPermitAppPg2.doc 01/03
CITY OF TIGARD 24 -Hour • -
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested 7-30 AM PM BUP
Location 13 $ss Suite MEC
Contact Person ---- 11A4 �LcL Ph ( ) zig -8'7 Dg PLM
Contractor Ph ( ) SWR 3 BUILDING Tenant/Owner `M U CJI 3 \ ELC -Da 5
Footing ELC 0 9--‹f' 7
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear \ „ N
Framing Y �-C i
Insulation S .�
Drywall Nailing
Fi rewall
Fire Sprinkler ,,r
Fire Alarm � , V t\f ) S \ 'N
Susp'd Ceiling -
Roof If iD
Other:
Final
PASS PART FAIL \ C
PLUMBING � W l
Post & Beam
Under Slab
Water he
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
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fi •arm
dry- Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
• • SS PART FAIL
SITE ❑ Please call for reinspection RE: 111 Unable to inspect - no access
Fire Supply Line
ADA d -� O
Approach/Sidewalk Date Inspect° Ext
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL