Permit C ITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2005 -00189
�j �n DEVELOPMENT SERVICES DATE ISSUED: 3/29/2005
=- 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S103AB -00404
SITE ADDRESS: 11305 SW WALNUT ST ZONING: R -4.5
SUBDIVISION: LOT : JURISDICTION: TIG
Project Description: Temp power pole.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: 1 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: 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:
HARRIS, SEAN & JAMIE LITE -RITE ELECTRICAL
11305 SW WALNUT 28820 SW BURKHALTER RD
TIGARD, OR 97223 HILLSBORO, OR 97123
Phone: 503- 591 -1337 Phone: 503- 648 -9744
FEES Reg #: LIC 89854
Description Date Amount SUP 4041S
ELE 34 -358C
[ELPRMT] ELC Permit 3/29/2005 $66.85
[TAX] 8% State Surcharge 3/29/2005 $5.35 REQUIRED ITEMS AND REPORTS
Total $72,20
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 qu- '•ns to OUNC at 503 -2 6699 or
1- 800 - 332 -2344.
; ge
Issued By: Permittee Signature: 1/14 I di
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 = ,{ .; FOROFFICE,USE ONLY
City a' "Tigard Date/By: j t2 v y / Pe nm t No C, , / � l� Ga / /�
13125 SW Hall Blvd , Tigard, OR 97223 Plan Review ��"
Phone: 503.639.4171 Fax. 503 598.1960 F100 I DateBy: Other Permit Inspection Line. 503 639 4175 s•i Date Ready/By Ions / � ® See Page 2 for
Internet: www ci tigard or us Notified/Method 1 V Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction ❑ Addition/alteration/replacement Please check all that apply:
❑ Demolition IN Other:"' ❑Service over 225 amps, comm'l ['Hazardous location
t ❑Service over 320 amps — rating ❑ Buildng over 10,000 sq ft ,
CATEGORY OF CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential
14 1- and 2- family dwelling ❑ Commerciallindustrial ❑ Accessory building El System over 600 volts nominal units in one structure
['Building over three stories ['Feeders, 400 amps or more
❑ Multi family ❑Master builder [11 Other:
❑Occupant load over 99 persons ['Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress /lighting plan - RV park
7 ❑Health - care facility ❑Other.
Job no.: Job site address: 13 ��!� 1 Submit 2 sets of plans with any of the above.
T City/State /ZIP: �i 1 The above are not applicable to temporary construction service
� ��� 4 I 4 FEE* SCxEDULE
Suite/bldg. /apt. no : Project name Description I Qty. I Fee. I Total I {*
Cross street/directions to job site: New residential single- or multi - family dwelling unit.
Includes attached garage.
��� � "; �' 5'T, 1,000 sq. ft or less 145.15 4
Subdivision: '" �"� V Lot no.: Ea. add'l 500 sq ft or portion 33.40 1
Limited energy, residential 75.00 2
Tax map /parcel no.:
Limited energy, non - residential 75 00 2
DESCRIPTION OF WORK Each manufactured or modular
dwelling, service and /or feeder 90.90 2
Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER I 1=1 TENANT 201 amps to 400 amps 106.85 2
\ 401 amps to 600 amps 160.60 2
Name: \ "1 ryl c r _s ' j A---- 601 amps to 1,000 amps 240.60 2
Address: 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
(�7 J l `
'/)y 7 I Fax: ( ) 2 2000 0 c a mmps
ion
or less // Phone: � / l 66.85 1
Oner 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 El PERSON A. Fee for branch circuits with
_l_ service or feeder fee, each
Business name: „i t- .._ ` � branch circuit
r B . Fee for branch circuits 6.65 2
Contact name: 7? // / a/ '(y8� ; /,, without service or feeder fee, 46.85 2
Address: p ! each branch circuit
Q g 2 A( AWAL, , ! I` ",./.._ / j Each add'l branch circuit 6.65 2
City/State /ZIP: '7/'`7 Miscellaneous (service or feeder not included)
s Pump or irrigation circle 53 40 2
Phone: (6) kg 91 / Fax: : () / v 1 Y l IC7 ,
� n JJ Sign or outline lighting 53.40 2
E - mail: L l - +� C /L /y� ,. ' / Signal circuit(s) or limited -
CONTRA C /25
O • `'� J energy panel, alteration, or
�O J / extension. Describe: Page 2 2
Business name: d � ', — • /
1 J / � •
_, i.il/ / /
Address: • ' ! , U /r �� E additional inspection over allowable in any of the above
g`• A I / E A�. � r �za ! Per inspection 62.50
City/State /ZIP: A�� / ./ % _ `'//,rI/ Investigation per hour (1 hr mm) 62.50
Phone ) ��/ �// Industrial plant per hour 73.75
y �1 !� /� ELECTRICAL PERMIT FEES*
CCB Lic.: a l �� �A Supry ] ; c -: / Subtotal z�
Suprv. Electrician signature, requi r- d: ., i L , Plan review (25% of permit fee)
Print name: i�'' Date'. /, State surcharge (8% of permit fee)
-- �/ tur ' •' .fr TOTAL PERMIT FEE b
Authorized signature �,I ,i This permit application expires if a permit is not abtaine vh�BD
: /� -- days after it has been accepted as complete
Print name: / o : i.�� • ` �_
Date * Fee methodology set by Tn - Building Industry Service Board
w Number of inspections per permit allowed
c \Building\Permits\ELC- PermitApp doe 12/03 440- 4615T(10 /02/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 system $75.00
(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*
e Protective Signaling
-❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
\ Buildmg\Pertnns'ELC- PertniApp.doc 04/03
CITY OF TIGARD ,
BUILDING DIVISION PERMIT #: ELC200S -001B9
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/29/2005
Phone: (503) 639 -4171 a -i'kaki 1l
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 3/30/2005 TIME: 7 :11AM PAGE: 43
SITE ADDRESS: 11305 SW WALNUT ST CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: HARRIS
DESCRIPTION: Temp power pole.
OWNER: HARRIS, SEAN & JAMIE, PHONE #: 603 -691 -1337
CONTRACTOR: LITE -RITE ELECTRICAL PHONE #: 503 -648 -9744
Inspection Request Scheduled For: Date: 3/30/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
110 Temporary electrical service 003211 -01 503-706.7333 N
V
Corrections/Comments/Instructions:
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'I:/ P SS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
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AIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED lie
77-30-J5
Inspector: • Date: 0 Phone #: (503) 718-