Permit •
C ITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2005 00178
Yl
DEVELOPMENT SE (VICES DATE ISSUED: 3/24/2005
11 � 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 1S136AD-01800
SITE ADDRESS: 06805 SW PINE ST ZONING: R -4.5
SUBDIVISION: VILLA RIDGE LOT : 002 JURISDICTION: TIG
Project Description: Service and 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: 1 W /SERVICE OR FEEDER: 7 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:
CARDENAS, MICHAEL H /SANDRA J ACCESS ELECTRIC AND CONST.
6805 SW PINE ST 17509 NW AUTUMN RIDGE
TIGARD, OR 97223 BEAVERTON, OR 97006
Phone: Phone: 503 - 372 -5770
FEES Reg #: ELE 34 - 675C
Description Date Amount SUP 193 S0
p SUP 49311 5
[ELPRMT] ELC Permit 3/24/2005 $126.85
[TAX] 8% State Surcharge 3/24/2005 $10.14 REQUIRED ITEMS AND REPORTS
Total $136.99
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 -801 •32 -2 • .
Issued By: • wit % ! 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.
1lecArical Per l`;?. 3+ 111. EtIlui ED rolz (slier.: (.JSE um.,
City g of Tigard • Received j
DateB . a Ir 5 .. % Permit No.' _ - — — a/ �S / 1
�l
d _
Phone: 503.639.4171 Fax: 503.
13125 SW Hall Blvd., Tigard, OR 7 6 Plan Revie
,
0� 4 2005 i'' -, 5 , i DateIB . Other Permit:
, tS.jV' - `i'
Inspection Line: 503.639.4175 _OA- ' Date Ready/By: luris: See Page 2 for
Internet: www.ci.tigard.or.u�,ITY OF TIGARD Notified/Method 71G M
Supplemental information
BUTT .nom Wirf ` ON PLAN REVIEW
❑ New construction iff Addition/alteration/replacement Please check all that apply:
❑ Demoli on El Other: ❑Service over 225 amps, comm'I 0 Hazardous location
❑Service over 320 amps - rating ❑ Buildng over 10,000 sq. It,
CATEGORY OF CONSTRUCTION of l- and 2- family dwellings 4 or more new residential
1 - and 2 family dwelling ❑ Commercial/industrial ❑ Accessory building OSystem over 600 volts nominal units in one structure
❑Building over three stories ❑Feeders, 400 amps or more
12 Multi - family 0 Master builder ❑ Other;
❑Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION DEgress/lighting plan RV park
Job no.: Job site address: (D605 Sur PIM ❑Health -care facility ❑der:
Submit 2 sets of plans with any of the above.
City / State/ZIP: "1n /_A1l4 , CI') 22 -5 The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: `� Project name: C elks FEE* SCHEDULE
Desaiptioo I Qty. I Pee I Total I ••
Cross street/directions to job site: G al° . pi 0 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'I 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
,Q ,� dwelling, service and/or feeder 90.90 2
�a v 1C_ V�etA >r ' r '"c_ "off'." Services or feeders installation, alteration, and/or relocation
A tbi er P .p„ok a tk a t ew t-T-c 200 amps or less l. 80.30 toao 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
((
/� Name: \ \1 - E CAL i\ �A-S 601 amps to 1,000 amps 240.60 2
Address: V• 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
Phone: ( ) - Fax: ( ) relocation
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 7 6.65 y L 2
Business name: branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee, 46.85 2
Address: each branch circuit
Each add'I branch circuit 6.65 _ 2
City/ State/ZIP: Miscellaneous (service or feeder not included)
Phone: ( ) 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
extension. Describe: Page 2 2
Business name:
kcc.�� CSC- cntic A,,..l, ssaucne.. ac
Address: I - 1 S C) OI N vj 1 �t�tti � - ► e tl E J) Q (JL' Each additional inspection over allowable in any of the above
Per inspection 62.50
City /State/ZIP: ?-7t-414.‘/C4,./-1,,,.. t of_ • 9? Coco Investigation per hour (1 hr min) 62.50
Industrial plant per hour 73.75
Phone: (45-0) S12_ . S77 d Fax: (503) WI O. 571)9 ELECTRICAL PERMIT FEES*
CCB Lic.: I G2.(o(.(, Electrical Lic.: .. L - fC,0 Suprv. Lic.: J(5 Subtotal (Z( 2$1
Suprv. Electrician signature, required: V Y f 3 Plan review (25% of permit fee)
Print name: W 7 11{lil--- ���"`��� Date: State surcharge (8% of permit fee) /(5 •
tom: LI Wl.M4 1, 4---- IZ� f �� TOTAL PERMIT FEE r 36, 1 . 4
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: Date: • Fee methodology set by Tri- County Building Industry Service Board
• • Number of inspections per permit allowed.
i:\ Building \Pennits\ELC- PamitApp.doc 12/03 410- 4615T(10/02/COM/WEB
c }• ,
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' nvolved:
❑ Audio and Stereo •ystems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and A' Conditioning
System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial system 7.00
(SEE OAR 918- 260 -260)
•
•
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Install • ion
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Syste
❑ Landscape Irrigation Con ol*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Li: ting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
i:\ Building\Permib\ELC- PemitApp.doc 04/03
CITY OF TIGARD
BUILDING DIVISION ,• PERMIT #: ELG2005 00176
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/24 /2005
Phone: (503) 639- 4171Pr PI�I
Inspection Requests (24 Hrs.): (503) 639 -4175 :��
INSPECTION WORKSHEET FOR DATE: 10/26/2005 TIME: 7:07AM PAGE: 94
SITE ADDRESS: 06805 SW PINE ST CLASS OF WORK:
SUBDIVISION: VILLA RIDGE LOT #: 002 TYPE OF USE:
PROJECT NAME: CARDENAS
DESCRIPTION: Service and branch circuits.
OWNER: CARDENAS, MICHAEL H & SANDRA J PHONE #: 503- 245 -6549
CONTRACTOR: ACCESS ELECTRIC AND CONST.LLC PHONE #: 503 -372 -5770
Inspection Request Scheduled For: Date: 10/26/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message f
199 Electrical final 019352 -01 503 - 642 -4333 Y c'Q liz g , 7
1
M , (, 41 L - ayta . 5_ - 7 ,lrr /W (AM lZ 1 l
Corrections /Comments /Instructions:
/ I l , & 6 e
66 PA
X ' PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CA L FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 0 I Date: ft'
Z6 0.,-r Phone #: (503) 718-