Permit , .' CITY OF TIGARD " ELECTRICAL PERMIT
1104 ° PERMIT #: ELC2007 -00572
° COMMUNITY DEVELOPMENT
D ATE ISSUED: 8/15/2007
TIGARD - 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 25101 DD -00600
SITE ADDRESS: 06700 SW SANDBURG ST ZONING: C -P
SUBDIVISION: SALEM FREEWAY SUBDIVISION LOT : 003 JURISDICTION: TIG
PROJECT: WESTERN FAMILY
Project Description: 3 branch circuits AC for computer room.
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:
WESTERN FAMILY HOLDING INC EAGLE GROUP INC.
PO BOX 4057 PO BOX 1369
PORTLAND, OR 97208 ESTACADA, OR 97023
•
Phone: Contact #: PRI 503 - 816 -8042
• FAX 503 - 631 -3655
FEES
Description Date Amount Reg #: ELE C163
[ELPRMT] ELC Permit 8/15/2007 $60.15 LIC 169776
[TAX] 8% State Surcharge 8/15/2007 . $4.81 SUP 5124S
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 • suance, or if work is suspended for
more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notifi = ion enter. 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 UNC .t 503.246.6699 or 1 -00 32.2344.
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 Applicati FOR OFFICE USE ONLY
` •� City of Tigard Date/By: I 15 jQ 1 - 5 6 Permit �1 / • O 0 7
13125 SW Hall Blvd., Tigard, OR 9722 1 5 2007 G Plan Review
Phone: 503.639.4171 Fax: 503.598.1 ^c Date/By: Other Permit:
TI G A IZ D Inspection Line: 503.639.4175 C% I tt O't TIGARD Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard- or.gov AuILO NGD%VI ("soN Notified/Method: Supplemental Information
TYPE OF WORK tYt� V'`� PLAN REVIEW
❑ New construction 0 Addition/alteration /replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
El- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. . ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system. A
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job no. j Job site address:"?? 5' ,,{J S �� � �� Six or or more. occupancy.
/ ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: ❑ Health-care facilities. ❑ Supply voltage for more than
/�/9/Q ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no f I Project name: /-.- �' /6 , 3 � ❑ Service or feeder 600 amps or more
FEE SCHEDULE
Cross street/directions to job site: 7 743 . ,2,/„AiA,� _ Description I Qty. I Fee. I Total 1 •
New residential single- or multi - family dwelling unit.
i �!r Includes attached garage.
Subdivisioti7 '''e7 Lot no.: 1,000 sq. ft. or less I 145.15 4
Tax map/parcel-no.: Ea. add'I 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
/ ^ � �ti� l /tilr7 r
Limited energy, multi-family 75.00 2
G ,J' ,(� ` �I residential (with th above sq. fl.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
0 PROPERTY OWNER I // ❑ TENANT 201 amps to 400 amps 106.85 2
Name: e , S�� h j/ ,[ �—,�,e. 401 amps to 600 amps 1 60.60 2
� / �� s 601 amps to 1,000 amps 240.60 2
Address: ' 7 5 r G>'/, S "e7,, -,' , "4" Over 1,000 amps or volts 454.65 2
City/State/ZIP:
.4�� ei orry services or feeders installation, alteration, and/or
i
Phone: (S03 ) / 39 /3 .. Fax: • ) 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 599 amps 133.75 2
Owner signature: Date: Branch circuits- new, alteration, or extension, per panel
A. Fee for branch circuits with •
)]APPLICANT I CONTACT PERSON above service or feeder fee, 6.65 2
I K:-/L each branch circuit
Business name: 17)13,4. w B. Fee for branch circuits
without service or feeder fee, 46.85 (a5 2
Contact name0r /l/ /S ��OS p j first branch circuit '
Address: r 1 u � �/ 7 3i6 Each add'l branch circuit y 6.65 j& 2
Miscellaneous (service or feeder not included)
City/State/ZIP: .. /y `,4 O2 Each manufactured or modular 90.90 2
/' dwelling, service and/or feeder
Phone: �' / Fax:: )
3 ) D - � 3 raj' ,] � I ' � O �c� Reconnect only 66.85 2
E- mail:.oe,,', � / �' �e,h PA(0 , zi, - Pump or irrigation circle 53.40 2
l CONTRACTOR Sign or outline lighting 53.40 2
Signal circuit(s) or limited -
Business name: 0/P 2:://c r energy panel, alteration, or • Address: 5�,N,e /75 .1 extension. Describe: Page 2 2
City/State /ZIP: Each additional inspection over allowable in any of the above
Phone: ( ) /:)/).0/05i' I F ax: ( ) Cl 3 7/1 t //� Per inspection 62.50
f ' " Investigation per hour (1 hr min) 62.50
CCB Lic./sq77 I Electrical Lic.: �i Suprv. Lic.: 572 y , ' Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
_
Su rv. Electrician signature, required: �� �� / /0 1 O
P g q f� Subtotal: 6,n • 5
Plan review (25% of permit fee):
Print nam �/( 7 � R S � Date: �— / '9 7 — State surcharge (8% of permit fee): 31,:• Authorized signature: ll <. - TOTAL PERMIT FEE: 64A 94,
i � t g Date: � This permit application expires t a permit is not obtained within 180
Print name:
� � � days after r it has been accepted as s complete.
• Number of inspections allowed per permit.
l:\ Building \Permits\ELC- PermitApp.doc 05/23/06 440- 4615T(11/05 /COM/WEB .
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 Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918 - 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all•other installations
I:\BuildingWermits\ELC- PermitApp.doc 03/23/06
CITY OF TIGARD
BUILDING DIVISION - PERMIT #: ELC2007 -00572
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/15/2007
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 .. `'II
INSPECTION WORKSHEET FOR DATE: 8/16/2007 TIME: 7:00AM PAGE: 6
SITE ADDRESS: 06700 SW SANDBURG ST CLASS OF WORK:
SUBDIVISION: SALEM FREEWAY SUBDIVISION LOT #: 003 TYPE OF USE:
PROJECT NAME: WESTERN FAMILY
DESCRIPTION: 3 branch circuits AC for computer room
OWNER: WESTERN FAMILY HOLDING INC, PHONE #:
CONTRACTOR: EAGLE GROUP INC. ay-E. , N,, 5 PHONE #: 503- 816 -8042
Inspection Request Scheduled For: Date: 8/16/2007 Pour Time:
Code # Inspection Description Confirm #' Contact # Message
199 Electrical final 054 \\ 503 - 816 -8042 Y
2.... .R,
Corrections /Comments /Instructions: 1
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Cr-CZ• 3 .)4V"IN s 4w1tk EriT .i
NC,A I 1 c , V.. Z' S .
❑ PASS ' ARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ` ❑ ` CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 3 , t' Date: 4 41 4 01V . ) Phone #: (503) 718- 2)414(:'