Permit : � .� " OF TIGARD ELECTRICAL PERMIT
� �c PERMIT #: ELC2007 -00458
a '' � 4" A COMMUNITY DEVELOPMENT DATE ISSUED: 7/6/2007
'Ta � 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S110BA -05600
Sff E ADDRESS: 11865 SW WILDWOOD ST ZONING: R -2
SUBDIVISION: SHADOW HILLS LOT : 009 JURISDICTION: TIG
PROJECT: DEIGNAN
Project Description: Installation of (1) branch circuit for pond. Job No. F5789
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:
JOHN DEIGNAN FIVE STAR ELECTRIC, INC.
11865 SW WILDWOOD STREET PO BOX 555
TIGARD, OR 97224 BANKS, OR 97106
Phone: Contact #: PRI 503- 324 -0948
FAX 503 - 324 -0973
FEES
Description Date Amount Reg #: ELE 34 -665C
[ELPRMT] ELC Permit 7/6/2007 $46.85 LIC 158231
[TAX] 8% State Surcharge 7/6/2007 $3.75 SUP 46225
Total $50.60 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 b.:• - ccordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is
suspend- or more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted b fir Oregon Utility Notification Center.
Those r les are set forth in e *, R 52 - -0010 through OAR 952 -001 -0100. You may obtain c• • es of these rules or direct questions to OUNC at
503.26.6699q1.800.33 .2344.
IIP
Issue • By: ! ' i Permittee • '. nature: % e, ,
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:
• TRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N _ /if :" /� : ir( r DATE:
LICENSE NO: /40, - �
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.
a n A, f +ta 1 ,M b ..HOIC01 -I ICI I.- 0NF 1 M .�
Electrical I': e mit Application r�,.-.. t.� , . ,-� -� . ... _.�., w�:. ,, 4=ii .:� .�_A
Rec
City of Tigard Permit No.:
D at r; B Y : / .J 0 1 �x f�0�? OU
13125 SW Hall Blvd.. Tigard. OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.59 ; - 1E)1:4 ;f,', t'! �° + Date By: Other Permit.
Line: 503.639.4175 - ' t n Date Read} Bp:
pr,.., See Page' for
w 1 + �
Internet: ww.ci.tigard.or.us Y Notitied.'Method. Supplemental Information
TYPE O M ' � � . P LAN REVIEW
El New construction Addition;a�terat, iQp/ri l>;}b eJ'rtentt ' t" Please check :dl that apptp; •
'.--)1. $ t ter ' t ' ['Service over 225 stops. Comm - 1 ❑tlarardous location
El Demolition Oth r. 1 '
((((�` ❑ Service over 320 amps -- rating ❑Bulldog over 10.000 sq. h.,
CATEGORC of 1- and 2- family dwellings 4 or more new residential
0,1- and 2 - family dwelling ❑ C pii t4;talti dustrial 0 Accessory building ❑System over 600 volts nominal units in one structure
['Building over three stories ❑Feeders. 400 amps or more
❑ Multi family 0 Master builder 0 Other:
❑Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION ['Egress/lighting plan RV park
r � pQ i Q �,� f Cy Q ❑health -care facility ❑ Other:
....,.___
Job no.: i� 1 Q t Job site address: I(U o Ow W,� 34 Submit 2 sets of plans with any of the above.
City /State /ZIP: ((�� The above are nut applicable to temporary construction service.
��(. J ■ � T[2.2.4 FEE* SCHEDULE
Suite /bldg. /apt. no.: Project name:1 i M
Vd t 1 r 1 max, Destriptioo J Qty. 1 Fee. / Total 1 -"
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. addl 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
y O �^� d C� wick - 0 , Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
El PROPERTY OWNER 0 TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 1 60.60 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
relocation
Phone: ( ) Fax; ( ) 200 amps or less 66.85 I
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 600 amps 133.75 2
Owner signature: — Date ------ Branch circuits - new, alteration, or extension, per panel
❑ APPLICANT ❑ CONTACT PERSON A. Fee for branch circuits 1111/1
service or feeder tee. each
Business name: branch circuit
6.65
B. Fee for branch circuits
Contact name: u•iIhoru service or tecder fee. Q �/ q1.
each branch circuit ` 4(i
1'S ' 4(1215 `
Address: Each add'1 branch circuit 6.65 2
City /State /Z_iP: %iiscellaneous (service or feeder not included)
Pump or irrigation circle 53 40 2
Phone: ( ) Fax: :
Sign or outline lighting 5:1.40 2
E -mail: Signal circuit(s) or !itnited-
CONTRACTOR energy panel, alteration. or
extension. Describe: F'aec 2 2
Business name: Five Star Electric, Inc.
Address: PO Box 555 Each additional inspection over allowable in any of the above
Per inspection 62.50
City /State /ZIP: Banks, OR 97106 Investigation per hour (t hr min) 62.50
Phone: (503) 324 - 0948 Fax: (503) 324 Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
CCB Lic.: 158231 Electrical 1.ic.: 34-665C Suprv. 1.ic.: 4622C
Subtotal "l�• D 3
Suprv. Electrician signature. required: . , , . Plan review (25% fee)
/
Stab: surcharge (8 °0 of permit lee) 3, 75
Print name: V O a 1 a C+�i ns Date: - / /n
� A ✓ 1 5/ ToTAL PERMIT FEE Q j i
Authorized signature: This permit application espires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: Date: • Fee ,nedtr.ioion ;el by i ri- Count} BuitdinE Industry Seivrce Hoard
'* Numuer of tnsp. cllons pi.r point allowed
r\ ltniklinmPennitc `.Ftf'- pvrmit Ann rim. 111th 1.0.14 rcnrnm1o
10•d 3nLL3a'I2 21YZS SnII3 8 :OT L003 - 90 -'I11f
n OF TIGARD Elc. ad' ? - GtySt
BUILDING DIVISION PERMIT #: ELS 9 802.6.- 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 ,
,g ∎ i I ;
Inspection Requests (24 Hrs.): (503) 639 -4175 .���,., ;,
i 1
INSPECTION WORKSHEET FOR DATE: 1 1 31 r Q9 TIME:/1'. OOp��\I, PAGE:
+ c
SITE ADDRESS: i ($ 65 S I.) W 1 LO WOOD 57- CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION: c.K'r '00. Peob
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date:11 Tifil
Code # Inspection Description Confirm # Contact # Message
1gct FiNNL_
Corrections/Comments/Instructions:
tM v 61" o3 T A N A = a. l r R_D"
1 s1i4A ® k(z et n- - 3et- )o C
PASS 1 1 PARTIAL APPROVAL n CANCEL 1 1 NO ACCESS
yL FAIL 1 1 CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: 6— ` 1 k 0• k--:G Date: n 101 Phone #: (503) 718 - 14 I ‘CY