Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2003 -00591
DEVELOPMENT SERVICES DATE ISSUED: 9/22/03
� IIII 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171
PARCEL: 2 S 102 CA -00924
SITE ADDRESS: 13220 SW VILLAGE GLENN DR
SUBDIVISION: VILLAGE GLENN ZONING: R-4.5
BLOCK: LOT : 024 JURISDICTION: TIG
Project Description: Upgrade elec. to 200 amp service.
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: 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:
•
JOHNSON, JAMES P + CHARLENE R WILSONVILLE ELECTRIC INC
13220 SW VILLAGE GLENN DR PO BOX 845
TIGARD, OR 97223 WILSONVILLE, OR 97070
Phone: 503 - 684 -2737 Phone: 503 - 638 -5353
Reg #: SUP 3854S
LIC 75752
FEES ELE 3 -307C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 9/22/03 $80.30
[TAX] 8% State Tax 9/22/03 $6.43 Rough -
Elect'I Service
Total $86.73 • Elect'I Final
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes .. all oth-r applicable laws. All
work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days • ssu -nc- or ' irk is suspended
for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility ■ • ificatio2 C: ter. ose rules are set
forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or dir: t . • tions to OUN ' at (50 246 -66.9 or
1- 800 - 332 -2344.
Issued By: Permit Signat r J�_
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 1.
Electrical Permit A lication FOR OFFICE USE ONLY
� .. q ' �� ReceivedC( f 1Q Electrical �� jj
'C tN E D Date/By: / 916 3 Kee PermitNof� -d )3 --z90 /
City of Tigard Planning Approval Sign
y g DateBy: Permit No.:
13125 SW Hall Blvd. SEI' 2003 Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503- 639 -4171 Fa ,.�q�, Post- Review and Use
�1 �o
1"1ll�fiiTU i iyMU ' h ��Yo„ I ,- Date/By: Case No.:
Internet: www.ci.tigard.o> I�DINC3 DIVISION Contact
24 -hour Inspection Request: 503- 639 -4175 - Namect e/Method: J ri Su See Page l for
P Q Name/Method: ��� Supplemental Information.
. , ;.T1'PE.,Q wow— ' yr :... ; :.. g... - :' {.Y PLAN RE VV (Please check all-that apply)
❑ New construction ❑ Demolition ❑ Service over 225 amps- ❑ Health-care facility
commercial ❑
❑ Addition/alteration/replacement ❑ Other: Hazardous
0 over 320 amps - rating of ❑ Building ding o over er 10 10,000 square feet,
_ .. ; _ 'CATEGORY`=OE CONSTRUCTIO+` ', _ 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
ID Accessory Building El Multi- Family
❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other:
. _, ; JOR SITE INFO _ Submit _ sets of plans with any of the above.
RIVIATI and LOCATION ,, ?:. The above are not applicable to temporary construction service.
Job site address: p 4 � - i x- - .
2 22. 1 ScJ_(/ /z1 �.� �, .. ,: , ,, z ..
cJ � � . _ .� _ F>✓'l � * �SCT�EDULE -:� �� y:.
Suite #: Bldg. /Apt. #: Number of inspections per permit allowed
Project Name: Description Qty Fee (ea.) Total
Cross street/Directions to job site: New residential - single or multi - family per 1
dwelling unit. Includes attached garage.
Service included:
1000 sq. ft. or less 145.15 4
D DmA- 14 Each additional 500 sq. ft. or portion thereof 33.40 1
Subdivision: ?� Lot #: Limited energy, residential 75.00 2
Limited energy, non residential 75.00 2
Tax map /parcel #: Each manufactured home or modular dwelling
. , . DEscitipoos pkwoRrc - , , ' . - p service and/or feeder 90.90 2
Services or feeders - installation,
alteration or relocation:
200 amps or less / 80.30 rn 0 2
201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
❑ PROPERTY OWNEIC -, .1 i ® =BEN `ANT ;' ,.,;_ _ * t ...,... - ' 601 amps to 1000 amps 240.60 2
Over 1000 amps or volts 454.65 2
Name: Reconnect only 66.85 2
Address: S Pq'i . 6 Temporary services or feeders - installation,
alteration, or relocation:
City /State /Zip: 200 amps or less 66.85 1
Phone: ,0 - 3. 6141 - 1 Fax: 201 amps to 400 amps 100.30 2
401 to 600 amps 133.75 2
'' ❑ APPLICANT• . '- III 'CONT►CT.PERSON, Branch circuits - new, alteration, or
Name: extension per panel:
Address: A Fee for branch circuits with purchase of 6.65 2
service or feeder fee, each branch circuit
City /State /Zip: B. Fee for branch circuits without purchase of
service or feeder fee, first branch circuit 46.85 2
Phone: Fax: Each additional branch circuit 6.65 2
E -mail: Misc.(Service or feeder not included):
4' {: y : ' . e r.* . Each pump or imgation circle 53.40 2
`CONTRACTOR Each sign or outline lighting 53.40 2
Job No: IJ3/Lat .,,, rJ V'i / ; L e.... Signal circuit(s) or a limited energy panel,
Business Name: alteration, or extension Page 2 2
Description:
Address: l �yc
k Each additional inspection over the allowable in any of the above:
City /State /Zip: tJ(1 v c ,�) y , ., f t t�lL .17 Per inspection per hour (min. 1 hour) 62.50 , Phone: 1, • - : '( - , (/ Investigation fee:
Other:
CCB Lic. #: 7.T7.cp— • 3 3x"7 r1 , , �: " ;.,:. Ar,.,,s,
Supervising ele a = - / n— / — v `-t Electrical hermit Eek"s
P g 9 i • Subtotal ::. $. ere, 3 c,
si: ature re • uired: _1 ie411P' — Plan Review (25% of Pernut Fee) $
Print Name: • • ' ‘. ' ,- ' ai 1 ic. ..r3 a7 5.-e/s State Surcharge (8% of Permit Fee) $ & • 3
TOTAL PERMIT FEE $ 81x. `7 3
Authorized Notice: This permit application expires if a permit is not obtained within
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\Perrnit Forms \ElcPermitApp.doc 01/03
4..
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
El Garage Door Opener
El Heating, Ventilation and Air Conditioning System
Vacuum Systems .
0 Other
COMMERCIAL WORK ONLY: •
Fee for each system $75.00
(SEE OAR 918 - 260 -260)
.) L
Check Type of Work Involved:
❑ Audio and Stereo Systems •
0 . Boiler Controls
• Clock Systems
n Data Telecommunication Installation
Fire Alarm Installation
HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
El Landscape Irrigation Control
n 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\Permit Forms\ElcPermitAppPg2.doc 01/03
CITY OF TIGARD 24-Hole. .
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
✓ /Z
Received Date Requested q"" 2& 7 AM � . PM BUP
Location _a 4 ! -4f l,1 tLJIr` - Suite MEC
Contact Person e Ph ( ) X03 r -53.53 PLM
Contractor CA) IS h U eC_ - Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing _ 00 SR'
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam t U) heV -- 1 - - rX INZ
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler -/
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
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
04fervic0
Rough -In •
UG /Slab
Low Voltage
-_rm ,�
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
111111 J PART FAIL
SITE Please call for einspection - E: ❑ Unable to inspect — no access •
Fire Supply Line
FDA
Approach/Sidewalk Date I 6 InspeCtoCti• -- _ Ext
Other:
Final DO NOT REMOVE this Inspection record fro - the job-site.
PASS PART FAIL