Permit 1 CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT
PERMIT ISSUED E 1/2008 00245
DATE ISSUED: 5/1/2008
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S 104AD -04500
SITE ADDRESS: 12617 SW WALNUT ST ZONING: R -4.5
SUBDIVISION: TVF &R FIRE STATION LOT : JURISDICTION: TIG
PROJECT: TUALATIN VALLEY FIRE AND RESCU
Project Description: Temporary electrical service and (5) circuits for construction and job trailer.
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: 5 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:
TUALATIN VALLEY FIRE & RESCUE B &C NORTHWEST ELECTRIC INC
20665 SW BLANTON ST DBA HORIZON ELECTRIC
ALOHA, OR 97007 1818 16TH ST
WEST LINN, OR 97068
Phone: 503 - 649 -8577 Contact #: PRI 503 - 650 -6540
FAX 503 - 650 -6562
FEES
Description Date Amount Reg #: ELE C343
[ELPRMT] ELC Permit 5/1/2008 $100.12 LIC 178708
[TAX] 12% State Surchar 5/1/2008 $12.02 SUP 4445S
Total $112.14 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 a in acco • - ce with - ..roved plans. This permit will expire if work is not started within 180 days of issuance, or if work is sus • =ailed for
more th 180 days. ATTEN 0 • Ore.o w equires you to follow rules adopted by the Oregon Utility Notification Center. Those rules - et forth in
OAR 9 2- 001 -0010 through OA" 952 -00 -0100. You may obtain copies of these rules or direct questions to OUNC at 503 246 =9 or .: .332.2344.
Issu d 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 IlaTAL , TION ONLY
SIGNATURE OF SUPR. ELEC'N: I - �, ' /171 f /d��' DATE: /4 g
LICENSE NO: 4 ` �
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 Applic O,1
' roe ()Frio: a rri ol_\
City of Tigard E. � 1 `' D _ /!, g �T�� s4.-
c�asi
t P ermit No
• 13125 SW Hall Blvd., Tigard, OR 97223 plan Review Other permit
® . ', Phone: 503.639.4171 Fax: } �? 503.59 �Vt ^ i Date :
Inspection Line: 503.639.4175 � ® 2 01J / i l Date Ready/By: to ga Page 2 for
I' I G \ I ' _ Internet www.tigard-or.gov Notified/Method Supplemental Information
�6YF� 6•x•: • ' +'e :, .• - .
TYP F�VOIK. i til�fi PLAN REVIEW
r 19„ea. X` 'P e I "a4,...•
NI New construction ❑ Addi on/iilteration/replac ei it - 1 ti Please check all that apply (submit 2 sets of plans w /items 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
❑ 1- and 2- family dwelling F 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 ❑ Addtuon of new motor load of ❑ "A", "E", "1 - ", "1 - ",
Job no.: Job site address: Walnut I00HP or more icy
12585 St. ❑ Six or more residential emits. ❑ Recreational vehicle parks
C ILy /State/ZIP. ❑ Healthcare facilities 0 Supply voltage for more than
Tigard, OF 97773 ❑ Hazardous locations 600 volts nominal.
suite /bldgiapt no.: I Project name: TVF&R Station # 50 ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I ttty. 1 Pee. 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'[ 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential
75.00 2
DESCRIPTION OF WORK (with above sq. R)
Limited energy, multi - family 75.00 2
Temporary Service, 5 Circuits residential (with above sq. ft )
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
401 amps to 600 amps 160.60 2
Name: Tualatin Valley Fire And Re _ . 601 amps to 1,000 amps 240.60 2
Address: 20665 Blanton St. Over 1,000 amps or volts 454.65 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
Aloha,_OR 97007 r el _ 66.85 1
Phone: ( ) I Fax: ( ) amps or less 1 66.85
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, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee,
each branch circuit 5 6.65 33.25 2
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee, 46.85 2
first branch circuit
Address: Each add'[ branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular 90.90 2
dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
. CONTRACTOR Sign nr outline lighting 53.40 2
Signal circuit(s) or limited -
Business name: B&C Northwest Electric Inc. dba Horizon Electric energy panel, alteration, or
extension. Describe: Page 2 2
Address: 1818 16th St.
City /State/ZIP: West Linn, OR 97068 Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (rio3)asn -654 F 03 50 - 65562 Investigation per hour (I hr min) 62.50
CCB Lic.: Electrical Lie - 34 Suprv. Lic.: Industrial plant per hour 73.75
5u� �q 17R7Q$ C343 44455 ELECTRICAL PERMIT FEES
y /F. if ectrician signature, requireF ip 7 — / /0////p Subtotal: 100.1
Print name: Terille Stavick / // Date: Plan review (25 %of permit fee):
t - - t : State surcharge (12% of permit fee): 12.02
Authorized signature: % �/� / / TOTAL PERMIT FEE.
/ � 112 14
/ This permit application expires if a permit is not obtained within 180
Print name: William J.. Pnstles Date: 05 -01 -08 days after it has been accepted as complete.
• Number of inspection allowed per permit
rlauilding \Penaita\ELCC- Petmitapp doe 05/23/06 440- 4615T(1 tro5/COM/Wm
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2008-00245
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/1/2008
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 I I..
INSPECTION WORKSHEET FOR DATE: 5/2/2008 TIME: 7:00AIYi PAGE: 19
SITE ADDRESS: 12617 SW WALNUT ST CLASS OF WORK:
SUBDIVISION: TVF &R FIRE STATION LOT #: TYPE OF USE:
PROJECT NAME: TUALATIN VALLEY FIRE AND RESCU
DESCRIPTION: Temporary electrical service and (5) circuits for construction and job trailer.
OWNER: TUALATIN VALLEY FIRE & RESCUE, PHONE #: 503.649 -8577
CONTRACTOR: B&C NORTHWEST ELECTRIC INC PHONE #: 50: - 650 - 6540
Inspection Request Scheduled For: Date: 5/2/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
115 Electoical service 069268 -01 503-650-6540 N
N A�
Corrections /Comments /Instructions:
sect,J i - ta - T. !a`p m it- at_ b 011.,.\6 .
1)0166 ,. ' ► 4 c...v s` $'E c.1;5 Jl.�
S 10 c. cw 1 ►
PASS RTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: GM oel Date: V1 Phone #: (503) 718- 1.40