Permit /9/ Q d "7" r � � p,?/ ELECTRICAL PERMIT
OFT A ( ) PERMIT #: ELC2003 -00640
D VELOPMENT SERVICES DATE ISSUED: 10/20/03
� II 13125 SW Hall Blvd.. Tigard. OR 97223 (503) 639 -4171 PARCEL: 1 S135DA 01000
SITE ADDRESS: 08530 SW PFAFFLE ST
SUBDIVISION: METZGER ACRE TRACTS ZONING: C -P
BLOCK: LOT : 020 JURISDICTION: TIG
Project Description: JOB NO 1920.13 Add circuits in basement. 10/30/03, add (1) 200 amp panel.
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: 1 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: 5 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:
DAVE DALTON TIGARD ELECTRIC INC
17930 SW MCEWAN 3201 S WYNOSKI A -1
TUALATIN, OR 97062 NEWBERG, OR 97132
Phone: 503- 267 -4419 Phone: 538 -5000
Reg #: LIC 26064
SUP 3940S
FEES ELE 34 -83C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 10/20/03 $86.75
[TAX] 8% State Tax 10/20/03 $6.94 Elect'I Service
[ELPRMT] ELC Permit 10/30/03 $80.30 Elect'I Final
(additional fees not listed here)
Total $180.41
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 0' - ' -el -:! 10 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503) 246-6699 or
1 -800- • -2344.
Issu - d By: � l_ j„ l A l .dih. L i a d.i 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 INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 639 -4175 by 7:00pm for an inspection the next business day
A 4 CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2003 -00640
DEVELOPMENT SERVICES DATE ISSUED: 10/20/03
"� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 1S135DA-01000
SITE ADDRESS: 08530 SW PFAFFLE ST
SUBDIVISION: METZGER ACRE TRACTS ZONING: C -P
BLOCK: LOT : 020 JURISDICTION: TIG
Project Description: JOB NO 1920.13 Add circuits in basement
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: 5 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:
DAVE DALTON TIGARD ELECTRIC INC
17930 SW MCEWAN 3201 S WYNOSKI A -1
TUALATIN, OR 97062 NEWBERG, OR 97132
Phone: 503 - 267 -4419 Phone: 538 -5000
Reg #: LIC 26064
SUP 3940S
FEES ELE 34 -83C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 10/20/03 $86.75
[TAX] 8% State Tax 10/20/03 $6.94 Elect'I Service
Elect'I Final
Total $93.69
This Permit is issued subject to the regulations contained in the Tigard Munidpat 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 6 -6699 or
1- 800 - 332 -2344.
Issued B : Permit Signature: 7 E
s Y g 1
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 639 -4175 by 7:00pm for an inspection the next business day
ti .a
Electrical Permit Application OFFICE USE ONLY
Date received: r Permit no. oa
a3_0N, /
, City of Tigard Projecdappl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Date issued: By: Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval:
7l'PE OF PERMIT •
❑ 1 & 2 family dwelling or accessory ,Commercial /industrial ❑ Multi - family ❑ Tenant improvement
❑ New construction 1 Addition /alteration/replacement ❑ Other: ❑ Partial
.IOB SITE INFORMATION
Job address: 'S3 0 S a). ' ce /e..-- Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: 'Block: 'Subdivision:
Project name: /, ) . Description and location of work on premises:A /
Estimated date of completion/inspecti • :
CONTRACTOR APPLICATION FEE SCHEDULE
Job no: 17.2o. / 3 Fee Max
Business name: / / qQ g / 7, 1 2 .... . yf Descri . ion Qty. (ea.) Total no. insp
Address: 3 ( f £4J/rlo06/�/ i v ? - New residential family per
dwellingtmit .lnclndesattachedgarage.
City: /gleam beef/ I State:0 I ZIP: c013 . Serviceincn 24,
Phone: j3 — ,ryg I Fax:5 j8 - 651 E- mail:, w „1 � i ll ,fi0o0,atiLil�/ol less 4
CCB no.:,26 0 e / I Elec. bus. lic. no: 3 q(- V Cj Each additional 500 sq. ft. or portion thereof __
Limited energy, residential ___ 2
City/met lic. no.: / 5 3 Limited energy, non - residential ___ 2
Glie- Lrde-OrGy—____ /0 ' 20 . Q 3 Each manufactured home or modular dwelling
Signature of supe ising electrician required) Date Service and/or feeder 2
Sup. elect. name (print): • n6 Aa 1 . rut S o,-. License no: ST $ Servicesorfeeders— installation,
alt or relocation:
PROPERTY OWNER 200 amps or less 2
Name (print): 201 amps to 400 amps 2
Mailing address: 401 amps to 600 amps 2
601 amps to 1000 amps 2
City: I State: I ZIP: Over 1000 amps or volts 2
Phone:. I Fax: I E -mail: Reconnect only I
Owner installation: The installation is being made on property I own Temporary services or feeders -
which is not intended for sale, lease, rent, or exchange according to installation,alteration , orrelocatlon:
ORS 447, 455, 479, 670, 701. 200 amps or less 2
201 amps to 400 amps 2
Owner's signature: Date: 401 to 600 amps 2
. ENGINEER Branch circuits - new, alteration,
or extension per panel:
Name: A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
City: State: ZIP: B. Fee for branch circuits without purchase
Phone: Fax: E -mail: of service or feeder fee, first branch circuit: 2 •
Each additional branch circuit: 1 ] J
PLAN REVIEW (Please check all Ihal apply) Misc. (Service or feeder not included):
❑ Service over 225 amps-commercial ❑ Health-care facility Each pump or irrigation circle 2
❑ Service over 320 amps- rating of 1 &2 ❑ Hazardous location Each sign or outline lighting 2
family dwellings ❑ Building over 10,000 square feet four or Signal circuits) or a limited energy panel,
❑ System over 600 volts nominal more residential units in one structure alteration, or extension* 2
❑ Building over three stories ❑ Feeders, 400 amps or more *Description:
❑ Occupant load over 99 persons ❑ Manufactured structures or RV park E ch additional inspection over the allowable in any of the above:
❑ Egress/lighting plan ❑ Other: Per inspection I 1 1 1
Submit sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other 7
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Permit fee $ f
❑ Visa ❑ MasterCard expires if a permit is not obtained Plan review (at _ %) $
Credit card number: I / within 180 days after it has been State surcharge (8%) $
Expires p complete. TOTAL $ 9'3.6 y
accepted as
Name of cardholder as shown on credit card
$
Cardholder signature Amount 440 -4615 (6 /00 /COM)