Permit CITY OF T IGARD TRICALMIT
+° a PERMIT ELEC #: ELC2008 PER 00590
COMMUNITY DEVELOPMENT • DATE ISSUED: 10/16/2008
TIGAR6‘ 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S 103DA -00400
SITE ADDRESS: 13150 SW WATKINS AVE ZONING: R -4.5
SUBDIVISION: DERRY DELL LOT : 004 JURISDICTION: TIG
PROJECT: O'LEARY
Project Description: (1) branch circuit for furnace.
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 HMI 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:
DAWN O'LEARY EVERGREEN ELECTRICAL CONTRACTOR
13150 SW WATKINS AVE PO BOX 567
TIGARD, OR 97223 BRIGHTWOOD, OR 97011
Phone: Contact #: PRI 503 - 209 - 1050
FAX 503 - 622 -1609
FEES
Description Date Amount Reg #: ELE 3 -472C
[ELPRMT] ELC Permit I0 /16 /200/ $46.85 L[C 136311
[TAX] 12% State Surchar 10/16/2001 $5.62 SUP 4581 S
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 thro = 0 52- 001 -0100. You may obtain copies of these rules or direct qua • OUNC at 503.246.6699 or 1.800.332.2344.
Issued y: _ 0_ :III ■ _ t
Perm ittee Signature: I� / �u +� —
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
4/ ,
SIGNATURE OF SUPR. ELEC' .� � + �riv i� ' 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.
.2008-10-15 15 :37 EVERGREEN 5036221609 » P 1/2
._ Electrical Permit A rlica !Luc- ° 5 5 � t t 4 ` ; ; ;; " Q ,y amr' 3' • r ( L . A t
City of Tigard Date/B / %. a g `9 y/ Petnm No.: ELL. gp08 - 00 5Y
4 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
0 Other Permit
Phone: 503.639.4171 Fax: so3.s98.b9�T 1 5 2003 DaeIBy:
C
a9 ' . Inspection Line: 503.639.4175 U �. Dote Reply By June RI See Page 2 for
Il i ._.. iJI„I ,
• Internet: www.ligard or.gov - OF TIGARD Not Read ethod: e7 (a Supplemental Information
TYPE 1 _,411' BB.. PLAN REVIEW
0 • i � 1; �dIS4 ®� Please check all that apply (submit j sets of plans w /items cheeked below):
New construction Additio : r •r V�+ 1 ❑ Service (ir feeder 400 am or more
Ps ❑ Building over throe stories.
❑ 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 ❑ Commercial /industrial ❑ Accessory building amps for all other install tons. buildings.
Multi family ❑ Master builder ❑Other: ❑Fire pump. ❑ Installat of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of sew motor load of ❑ "A ", "E ", "I -2 ", "I -3 ",
Job no.: 1 Job site address: 13150 SW Watkins IOOHP or snore. occupancy.
❑ Six OT more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: Tigard, OR 97223 ❑ Health-care facilities ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: 1 Project name: ❑ Service or feeder 600 amps or mom.
FEE SCHEDULE •
Cross street/directions to job site: Dekrt,ttaa . 1 Qty I Fee. I Total I '
New realdentlal single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: 1 Lot no.: 1,000 sq. ft. or Icss 145.15 4
• Tax map /parcel no.: Ea. add'I 500 sq. ft. or portion 33.40 I
Limited energy, residential
75.00 2
DESCRIPTION OF WORK Jwith above sq. a.) -
I circuit furnace Limited eid ntial energy, multi-family
r 75.00 2
residential (with above s0.. 6.)
Services or feeders installation alteration, and/or relocation
200 amps or less 80.30 2
0 PROPERTY OWNER 1 C3 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: ( ) Fax: ( ) 200 amps or less 66,85 1
Owner installation: This installation is being made on property that 1 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 esteusion,per panel
Owner signature: Date: A. Fee for branch circuits with
O APPLICANT I C3 CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: 13. Fee for branch circuits
— without service or feeder fee,
Contact name: first branch circuit 1 46.85 ,.L 0. 2
Address: Fach add'I hranch circuit 6.65 Po 2
Miscellaneous (service or feeder not included) _
City /State /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
Business name: Signal circuit(s) or limited -
r r q r et ' r ' \ e C. 't -y1(- energy panel, alteration, or
Address: .--)o 6 c ,,,,_ • J 5 •, extension. Describe: Page 2 2
� ri
/State /ZIP: �jhtu�> 'OK.. Cit y c = B r^ u l l Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (r-30.5 ) 2ti`rt I'0 5u Fax: (51) J .• a- (1p c) j Investigation per hour (1 hr mint 62.50
CCB Lie.; 1 'a 1 Electrical Lie.: r.{ 1 aC Suprv. Lic.: Li-58 i S Industrial plant per hour 73.75
7 I t t Ems ICAL PERMIT FEES
Suprv. Electrician signature, required: 1 Subtotal: -it,. 5
Print name: C L- r i C K eDC r Date; I Plan review (25% of permit fee): -
State surcharge (12% of it fee):
Authorized signature: i TOTAL PERMIT FEE: . 2 ' 7
This permit application cspirn if a permit Is not obtained within IN
Print name: I Date: days oiler It has been accepted as complete.
' Number of inspections allowed per permit.
I: 1BuiWctaTermitr \ELC•PemtitApp.doc 05/23/06 440.46157(11 /05 /CQMIWF.a
CITY OF TIGARD
BUILDING DIVISION PERMIT #: EI_C7008 00690
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/16/2m08 Phone: (503) 639 -4171 < i� A i
f
Inspection Requests (24 Hrs.): (503) 639 -4175 ! ° L.
INSPECTION WORKSHEET FOR DATE 10/21/2008 TIME: 7 :OOAiv'i PAGE: .14
SITE ADDRESS: 1 3160 SWWATKINS AVE CLASS OF WORK:
SUBDIVISION: DERRY DELL LOT #: atm TYPE OF USE:
PROJECT NAME: O'LEARY
DESCRIPTION: (1) branch circuit for furnace.
OWNER: O'i EARY DAWN PHONE #:
CONTRACTOR: EVERGREEN ELECTRICAL CONTRACTOR PHONE #: 503 - 2031060
Inspection Request Scheduled For: Date .10/211 2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical find 076980 02 50"S.275-8799 N
Corrections /Comments /Instructions:
/ ditaios
❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL CALL *R INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: ii ( 0 Phone* (503) 718 -