Permit C ITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2005 -00070
I DEVELOPMENT SERVICES DATE ISSUED: 2/9/2005
r � l I I 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S 102AB -01902
SITE ADDRESS: 09392 SW TIGARD ST
SUBDIVISION: NO.TIGARDVILLE ADDITION AMEND. ZONING: I -P
BLOCK: LOT : 055 JURISDICTION: TIG
Project Description: T.I. (10) branch circuits.
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: 9 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:
ATLAS LAND COMPANY WILLAMETTE ELECTRIC INC
9380 SW TIGARD PO BOX 230547
TIGARD, OR 97223 TIGARD, OR 97281
Phone: Phone: 503 - 624 - 3631
Reg #: LIC 75059
SUP 1965S
FEES ELE 34 -283C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 2/9/2005 $106.70
[TAX] 8% State Surcharge 2/9/2005 $8.54
Total $115.24
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.
•
Issued By: Permit 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 639 -4175 by 7:00pm for an inspection the next business day
FEB 09 2005 9:00AM HP LRSERJET 3200 p.2
E lectrical Permit A ' ! IV FOR OFFICE USE ONLY
City of Tigard Received -i e- Permit No.' // -ix 0
13125 SW Hall Blvd., Tigard, OR 97223
g fLtt5 Review
Phone: 503.639.4171 Fax: 503.598.1960 [E� "
0 _ A '�� �: +a cj Il' ? DateB : Other Permit
Inspection Lane: 503.639.4175 6 Date Ready/By: Mill RI See Page 2 for
Internet: www.ci.tigard.or.us - ma ! : -' ' _ � Notified/Method: Supplemental Information
Y i ill L§'6 i S 9 '! %1'� i Fg Q�, li v , ' G s�,Y ,"rF
7 , qq ,'4� W': ** i 3 t'aD xa+ �'li �r ". � r `. E ;2713 . °a.1 S`.r . .
4 9n. 1l_1 -I I i i • /F+ ti •5' '471��` a 1 i „ l �' c d [ , • f ( ' , 4 rz rrn � j: 0 v . . a� ,.d..:
� !��'?..��imlt�'���11��iC1,iLLt �li .. "�rS:�=a {T.� ^� ' �n1. iSi !�rd:i4'tiatt�. c,.. �'.� „� �"'�'_•b � � _ - .
Please check all that apply:
❑ New construction � „ , �.�• u on
❑Service over 225 amps, comrn'I ❑Hazardous location
❑ Demolition ❑ • her
� , ilti;7 �r, r, E s , al an r� as t k ;v >� wl g , •;i, :
❑Service over 320 amps - rating ❑Buildng over 10.000 sq. ft.,
Ill. � a .M1 .
e;41_.l . la:Cl . :'.? `� i `4nry to,,:el ,t,'aaL
!.1' : b0areti Vii ?- 14,i , �..:. s l �. , , . 1 s�;irl1 . _ i of 1 and 2-family dwellings 4 or more new residential
❑ 1- and 2- family dwelling gCommercialiindustrial ❑ Accessory building ['System over 600 volts nominal units in one structure
11 Multi - family ❑Master builder El Other ['Building over three stories [Weeders, 400 amps or more
t't. 7 � , , _ ,h1 1, ,� i is ❑Occupant load over 99 persons ❑Manufactiued structures or
t>t� s ., I , �t . 1, q u l� s A NI { 4 4,1 r rh� t J V I t it i ]1ik , ■ �, i nr . J RV park
N 1 :. :10:,,i,, : a l �,!1_Sf. i tY.i T ,le . . . t� d , -- ,1.. 1 _ , -d u �∎lr'; t1��I N i 1,➢ R ` L1.t411411 ❑ zv e ss , li g ht tngplan Par
Job no.: gI .. Job site address: 93 ,a S w T; 5 ,.. ,/, s ❑Health -care facility ❑Other.
Submit 2 sets of plans with any of the above. •
City/State /ZIP: .2- ■ t t� rL d Q 1, 9 ) t . - 3 The above are not applicable to temporary construction service.
Suite/bldg./apt no I Project name �_ 1 <; BE Via.` = i i e'° 1 , 1 ;4 fi% :
1 4 G . < Iry 1 L
Description Qty. Fee. Total
Cross street/directions to job site: New residential single- or multi- family dwelling unit.
- Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: [Lot no.: Ea. add'! 500 sq. ft_ or portion 33.40
Limited energy, residential 75.00 2
Tax map /parcel no.: Limited en
p� ! I , , t r , s unnei n .,2r , ,3 r r , id $y, non- residential 75.00 • 2
Itl'Llil� �FK;F &4' 4 14It ;I l 'ily; i s..1.1 n: siP.l ,° a 1. , {dt l ; th �f , I .H�l'1fiLI , t !1'il A ,..1 '. dal r � 1 ..1 .t . Fach manufactur or coodular
1 H I i 1 ' a 9 ! I _. li d d
dwelling, service and /or feeder 90.90 2
1 .,..i,..... I I I e 1 ..1-0 .....-1-✓' Services or feeders installation, alteration, and/or relocation _
200 amps or less 80.30 2 _
t n ' l 1 r P� 1 ! �u V.., � �i lf lr IE:- Illy I iyt��Tl k� r t . I r • I r r i "11,: rinai t :,' 201 amps to 400 amps 106.85 2
.l k':Itk4._Y,t�11 -, 4..i '.3St tLiFl O�i�._ti� tfineye.1.,.l!47,o, ,liftilibt;la. -1!Nrt :: ,ItL fit,:., ai VI+ tv iulilt,.
401 amps to 600 amps 160.60 2
Name: 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
Phone: ( ) I Fax: ( ) relocation
200 amps or less 66.85 1 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 600 amps 133.75 2
Owner signature: Date: Breach circuits - new, alteration, or extension, per panel
4 ji ' i 4°' i,,,1 .,' 4+ �^t,t +1 !, i�RR7 irrflv,v h � S 1 '^r , i , If1'I
. q , r i l.15A iY.tt tv,. , & - - � ! ,m4.1tmeiil ,i 'r i_..l.:rt 99 r, `��` ,, � ,,,. a f�.t?Ah . ., 1:.. ws' A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: branch circuit _
- B. Fee for branch circuits
Contact name: without service or feeder fee, /
each branch circuit I 46.85 ( s - 2
Address: Each add'l branch circuit 9 6.65 •-5 FA 2
City /State/ZIP: Miscellaneous (service or feeder not included)
Phone: ( ) I Felt:: ( ) Pump or irrigation circle 53.40 2
Sign or outline lighting 53.40 2
E-mail: Signal circuit(s) or limited -
k.IryryI11P� Lf� Gli �, a �flIlI,p,; ,! �y1,If if � �� y irr a 41�r)� ii. r ! ,1 �! *�•7 N 1kl non '
is "a'}, litr (. iteration, or
lf�fli9111[I_w i!ri l edfC'��Sl�'Ili .'iF.;'i19,.tl1�� :r.� {7! .-. �J ^�rlat7,itc.alrs�a.tr.�l��' 1.,.I . �1!.i.,�7ua. `�^ ,t LL'ILkle'll�fli: enerBY Panel, a
/ / l,� extension. Describe: Page 2 2
Business name: !A) I i! 4.sew1 & '7�.t 1Yld G i w e
Address: Each additional inspection over allowable in any of the above
r Q R aA 236 c v )- Per inspection 62.50
City/State/ZIP: r N //� 9 � Z k / Investigation per hour (I hr min) 62.50
Industrial plant per hour 73.75
Phone: (6'L' >) F ax: ( ) a,
:w�fi
bZY - 343 / S7r L 2 1 - � 3 ;44! � t ���f '1""" MI"ri,;',k:'A::t.. < "t
CCB Lic.: / S S I Electrical Lic.: Ty, as .. Suprv. Lic.: /9/ s _.� Subtotal X i
•
Suprv. Electrician signature, required: Plan review (25% of permit fee)
'� State surcharge (8% of permit fee) S S
Print name: I ,•.J p Date: Z,.., g- _ e � -
TOTAL PERMIT FEE I Z - Z!-
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: Date: • Fee methodology set by Tri- County Building Industry Service Board
- •• Number of inspections per permit allowed.
@1BuildinePee mh\ELC- Pmi 12103 440.4615r(10/02/COM/WE3
CITY OF TIGARD
BUILDING DIVISION PERMIT #: aO05- -ooO7O
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 I C I
Inspection Requests (24 Hrs.): (503) 639 -4175 "- _..
INSPECTION WORKSHEET FOR DATE: 317 TIME: PAGE:
SITE ADDRESS: q'192- I j y Ovv 0( 9fr. . CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER C PHONE #:
CONTRACTOR: 1' . i PHONE #: -3 I
Inspection Request Scheduled Fo • Date: Pour Time:
Code #199 Inspection Description Confirm # Contact # Message
Corrections /Comments/ Instructions:
PASS 111 ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Ni e Date: 3 2 - d 5 Phone #: (503) 718-