Permit CITY OF TIGARD ELECTRICAL PERMIT
M
PERMIT #: ELC2008 -00163
, • COMMUNITY DEVELOPMENT DATE ISSUED: 3/20/2008
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S102BC - 01300
SITE ADDRESS: 10230 SW WALNUT ST ZONING: R -4.5
SUBDIVISION: NO. TIGARDVILLE ADDITION LOT : 027 JURISDICTION: TIG
PROJECT: ZIGLINSKI
Project Description: Installing ground rods.
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: 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:
ANTHONY & PATRICIA ZIGLINSKI CHANCO INC
10230 SW WALNUT 3521 SW CARSON
TIGARD, OR 97223 PORTLAND, OR 97219
Phone: Contact #: PRI 503 - 245 - 7774
FAX 503 - 244 -4804
FEES
Description Date Amount Reg #: ELE C209
I I:LPRMTI ELC Permit 3/20/2008 $46.85 LIC 171892
I l'AX 112% State Surchar 3/20/2008 $5.62 SUP 688S
Total $52.47 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 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 1.800 332.2344
1
Issued By: � �` Permittee Signature: .41111 1111111■ , . !A N `—iha
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 Application � 2 FOR OFFICE USE ONLY ,. /p
Illir City Tigard S�; � „� Date/B . ,J 2r. / I p /377 No O,/ O ` 00/03
y
• 13125 SW W Hall Blvd ,Tigard, OR r ` 7 t- " �•, Plan Review
C Phone 503 639 4171 Fax: 503 598 1960 Q 2. Date/By Other Permit �x J�� a pq
TI G A It D Inspection Line 503.639.4175 MAR Date Ready /By orris El See Page 2 for
Internet: www tigard -or gov T 1 /± p Notified/Method Supplemental Information
OF Why 1 � O I SO PLAN REVIEW
❑ New co Addition /alte
MG Please check all that apply (submit 2 sets of plans w/rtems checked below)
❑ Service or feeder 400 amps or more ❑ Building over three stones
❑ 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
-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
❑ Emergency system larger separately derived system.
JOB SITE INFORMATION AND LOCATION
❑ Addition of new motor load of ❑ "A ", "E ", "I - 2", "1 - ",
Job site address: �J 100HP or more occupancy
Job no.:
0 !.� (] 5.4.„0 fL ❑ Six or more residential units ❑Recreational vehicle parks
City/State /ZIP: - 77 4 c (7 "7 2 Z ❑ Health -care facilities
❑Hazardous locations ❑Supply voltage for more than
600 volts nominal
Suite/bldg. /apt. no.: 1 I Project name: ❑ Service or feeder 600 amps or more
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. I Total I •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145 15 4
Ea. add'l 500 sq. ft or portion 33 40 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF W O (with above sq. ft) 75 00 2
� ' 67-d n n CZ Limited energy, multi-family
r"[ /� residential (with above sq ft.) 75.00 2 _
Services or feeders installation, alteration, and/or relocation
200 amps or less 80 30 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2
Name: 401 amps to 600 amps 160 60 2
601 amps to 1,000 amps 240 60 2
Address: Over 1,000 amps or volts 454 65 2
City/State /ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) I 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
Branch circuits - new, alteration, or extension, er panel
Owner signature: Date: A Fee for branch circuits with
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: B Fee for branch circuits
Contact name: without service or feeder fee, 46 85 �/_ 2
first branch circuit 1p
Address: Each add'I branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City/Statc /ZIP: Each manufactured or modular
dwelling, service and/or feeder 90 90 2
Phone: ( ) Fax: : ( ) Reconnect only 66 85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Signal circuit(s) or limited -
Business name:
&htm e 7 -- energy panel, alteration, or
Address: 3S S-eZ Gj 4-1.g.pvt �— extension. Describe. Page 2 2
City/State /ZIP: eQ y` *Pjp ,,_ 4 r �� 1 j 7 Z (r 1 f ' / Each additional inspection over allowable in any of the above
I L " �11 ` 1 (` Per inspection 62.50
Z
Phone: (SO V.._ 7 7 (( I Fax: 663 )Zygf tip l , Investigation per hour (1 hr min) 62.50
7
CCB Lic.:' / g I E Lic.: e 2 q I Su Lic.: gig.... Ind ustrial p lant per hour 73 75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: , / Subtotal. I 46. S(�
Print name: ( " (A.' (W L� /� Date: 3 �- Z0a Plan review (25% of permit fee): vU
State surcharge (12% of permit fee): 5; G (---
Authorized signature: TOTAL PERMIT FEE: 5 --I. I — 7
Print name: Date: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
• Number of inspections allowed per permit
t \Building\Permits\ELC- PermriApp doc 05/23/06 440- 4615T(I I /05 /COM/WEB
Electrical"PermitApplication - 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 91a
Check Type of Work Involved: •
❑' Audio and Stereo Systems
❑ Boiler Controls
❑, Clock Systems'
❑, Data Telecommunication Installation
❑, Fire Alarm Installation
❑i HVAC •
❑ .
`Instrumentation
❑' Intercom and;Paging•Systems
❑: LandscapeIirigation Control* •
® Medical •
❑ Nurse Calls __ ; S '
• , �' -- l ).• ‘i
❑' `
Outdoor Landscape - Lighting* , \ ,
40
Protective Signaling
❑- Other - • .
a .
Total number of commercial systems: _ , -
*Nci, licenses: are - required. Licenses are required
for all:other installations
I:\ Building\ Permits \ELC- PermitApp.doc.03/23 /06
CITY OF TIGARD ..
BUILDING DIVISION PERMIT #: ELC2008 -00163
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: ►20/200a
Phone: (503) 639 -4171 A Inspection Requests (24 Hrs.): (503) 639 -4175 ,I � ..
INSPECTION WORKSHEET FOR DATE: 3/21/20013 TIME: 7:01AM PAGE: 22
SITE ADDRESS: 10230 SW WALNUT ST CLASS OF WORK:
SUBDIVISION: NO. TI(3ARDVILLE ADDITION LOT #: 027 TYPE OF USE:
PROJECT NAME: ZIGLINSKI
DESCRIPTION: Installing ground rods.
OWNER: ZIGLINSKI, ANTHONY & PATRICIA PHONE #:
CONTRACTOR: CHANCO INC PHONE #: 503
Inspection Request Scheduled For: Date: 3/21/2003 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 067130-01 503-209.4778 N
Corrections /Comments /Instructions:
•
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 71S2 it.' ) Date: 3 - 21- Phone #: (503) 718-