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Permit CITY OF TIGARD ELECTRICAL PERMIT PERMIT #: ELC2006 -00610 COMMUNITY DEVELOPMENT D ATE ISSUED: 10/26/2006 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 2S103DA -03700 SITE ADDRESS: 10865 SW PARK ST �— ZONING: R -3.5 SUBDIVISION: LOT : JURISDICTION: TIG Project Description: 200amp service. 11/06/06: Added (1) 200 amp for garage panel. RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS 1000 SF OR LESS: 0 - 200 amp: 0 PUMP /IRRIGATION: EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG: LIMITED ENERGY: 401 - 600 amp: SIGNAUPANEL: MANF HM/ SVC/ FDR: 601 +amps -1000 volts: MINOR LABEL (10): SERVICE/FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS 0 - 200 amp: 2 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: GARY MITCHELL REDS ELECTRIC CO INC 10865 SW PARK 2002 SE CLINTON ST TIGHARD, OR 97223 PORTLAND, OR 97202 -2245 Phone: 503 - 522 - 6608 Contact #: PRI 503 - 233 -6467 FAX 503- 233 -1281 FEES Description Date Amount Reg #: ELE 26 -152C [ELPRMT] ELC Permit 10/26/200( $80.30 LIC 4443 [TAX] 8% State Surcharge 10/26/200( $6.42 SUP 5010S [ELPRMT] ELC Permit 11/6/2006 $80.30 (additional fees not listed here) REQUIRED ITEMS AND REPORTS Total $173.44 This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344. Issued By: � Permittee Signature: OWNER INSTALLATION ONLY The installation is being made on property I own which is not intended for sale, lease, or rent. OWNER'S SIGNATURE: DATE: CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR. ELEC'N: DATE: LICENSE NO: Call 503.639.4175 by 7:00 a.m. for an inspection that business day. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. •Nov. 3. 2006e_2L48_!pDhication No. 2627 P. 1 .� � City of Tigard Re�rcd baze/By. Permit No- 13125 SW Hall Blvd., Tigard, OR 97223 �`' ��� 6 �� ` y ) r 'L(_ _ LAC / Phone: 303.639.4171 Fax: Sp3,598. v Plan Review E Date/Br other Permit: Inspection Line: 503.639.4175 V .r 1,1. '� 1-. D teReady/By: iwis: ® �p�2 for Internet: www.e.tigard,or.us 3 'to s Notified/Method: Super � •. eme�tat r�r ��; � , �4 �� �� hr Vi i, • Y„ T{°• �{���� l.n >':r,. ice:: '{$..yY b\ :yA( \ } ! A: . A � :� 0, ,. �+.1i r YO . � 7!' y ... i:�: :,.. CAI . • i0`:: 'N.i ". "! A ._ ee r.`•• '• ;i.:.��.,.5.`•. R.J .._..� .- >�,i,! v �ti�•� �;� �,ro,.�A,r. sty.,^.- jid'.�r +'�,'. t^� '' F. .�5�`� r' �r i - 0 Ncw construction re Addi >T • + :. t.7, ' , ;� I,: .1.1! "ant Please check all that apply: 0 Demolition 0 OthaPUD ❑Service over 225 amps,comel ❑ Hazardouslocation `? Zv 5 +�'?:5� ^� y c y , ,. ❑Service over 320 amps - ratio Burl 0,000 aaf `•, ;`f!yr� * 3.��!, - �, •; ,,,_ '':.' r, ��' 8 ❑ dog over 1 s l�„ �. '�'� `�• ����'�� �� �? ^tea •" a ��:a;�;a "'• ��t- k:,;.. Y ngs 4 or more new residential 4 �.;, c ., k. r r•s :•�� � of I •and 2 -ftmil dwelli 11� I - and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building ❑SYstem over 600 volts nominal units in one structure ■ Multi - family ❑ Master builder 0 Oa ❑Building ova sauce stories ❑ Peeders, 400 amps or more ?tS;s , i t''sa ' s ��,,� y , ;, Y ❑Occupant load ova 99 rsons ❑Manufactured structures or �;: -. v 1 `_ .,, �t TIQ11 ? , t!� ; n{s A ' ❑Egre,s/lightmg purl RV park Job no.. 6:� Yob site address: , • l3 7. ❑1lcalth -care facility ❑Other: Submit 2 sets of plans with any of the above. City /State/ZiP: The above are not applicable to temporary construction service. Suite/bldg. /apt. no.: Project name: I ' : ` ` 5p ;a_` .,�. .,a ia;;i o' '' :FUR ` •�t 'a• t-; — neaalplloo QQ pea Tad •• Cross street/dircctions to job site: New residential single- or multi- family dwelling unit. Includes attached garage. 1,000 sq. f. or less 145.15 4 Subdivision: Lot no.: Ea. add'! 500 sq. ti. or portion 33.40 1 Tax map /parcel no.: Limited energy, residential 75.00 2 k , .,'r,'zti ' '} r'`a r f' r r r. � e ,;, .,, ' Limited energy, non -residential • 73.00 &: a i4 s' S i 1 t �2• ac ; i ., ;` yc.,, i': r s 2 !•- -� ;�.� Bach tnenulltcturcd or modular d_d / O )4y� dwelling, siaviceand>or'" _ 90.90 ` 2 Services or feeders iustallation, alteration, and/or relocation �.� - ' 200 amps or less 80.30 ?� ,33 2 3a ��� — � �fy �?s,t�-.�rc�.r,��,+, -,, S � "�` IMITI .�-ti.5 };��.I ' r' .Y ANAL'- •' •� •�` 3�3= .�1, 'y't„itti g. Ad 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/ZIN: Reconnect only 66.85 2 Temporary services or feeders installation, alteration, and/or Phone: ( ) I Fax: ( ) relontion Owner• iusfallaUon: This installation is bein made on r 200 or less 66.85 t intended for sale, leash re or atilt g P off' that I own which is not 201 amps to 400 amps 100.30 2 tit, atlge, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2 Owner signature: - „Y_ r r� Date: Branch cirenits - new, alteration, or extension, Per panel y, . ��,y;� V.- . T aw2r:Y i, r�j' r, A Fec for branch circuits with �"� "` service or feeder fee, each Business name: branch circuit 6.65 2 Contact name: B. Pee for braneb circuits without service or feeder fee, 46.85 2 Address: each branch circuit pity /StatdZIP: Each add'l br nch circuit 6.65 2 Miscellaneous (service or feeder not Included) Phone: ( ) I P ax:: ( ) Pump or irrigation circle - , 53.40 T -mail: Sign or outline lighting 53.40 2 (g2ti� ( ai .! r ✓J� �:�,� rn rZ. aS a... ray ; u Signal circuit(s) or limited - �W``11� , .; ..:�: is,a a it, iQ :;r '2 Ai�i energy panel, alteration. or extension.Desaibe: Paget 2 Business Reds Electric Company Address 2002 SE Clinton Each additional inspection over_ allowable in any of the above Portland, OR 97202 Per inspection 62.50 City /Staff (503)233-6487 Fax (503)233 -1281 Investi gation per hour (1 br min) 62.50 Phone: ( CCB# 4443 Elec Llc# 26 -152C Supry Llc.# 50105 Industrial plant per hour 73.75 CCB Ltt .�P /N' : �rz�".�1~�``.�, TCA'�..•1q�?!•>���rh�R,' "• ' Subtotal Suprv. Electrician signat re, required: '\ Plan review(25%ofpermit tiro) . Print ntunov 11N1 rw v l� Date: Z / 1 O(o State surcharge (89'0 of permit fee) ��(�� ►[[ TO [AL PEBMIT FEE r Authorlard signa : This permit application espir�es a permit Ia not o ed with Print.name• days after it has been accepted as complete Date: ' • Fee meUwdology set by Tri- County Building Industry Service Board islBuildtogWemria�FlC .Pr�mitAppdoc laro] •• Numberofinspectionsperpemtitallowed M0461S y1 anniCOm W C ITYOF TIGARD ELECTRICAL PERMIT PERMIT #: ELC2006 -00610 DEVELOPMENT SERVICES DATE ISSUED: 10/26/2006 —- h ��li 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S 103DA -03700 SITE ADDRESS: 10865. SW PARK ST ZONING: R -3.5 SUBDIVISION: LOT : JURISDICTION: TIG Project Description: 200amp service. RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS 1000 SF OR LESS: 0 - 200 amp: Q 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: 2. W /SERVICE OR FEEDER: 9 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: GARY MITCHELL REDS ELECTRIC CO INC 10865 SW PARK 2002 $E CLINTON ST TIGHARD, OR 97223 PORTLAND, OR 97202 -2245 Phone: 503 - 522 -6608 Contact #: PR] 503 - 233 -6467 FAX 503 - 233 -1281 FEES Description Date Amount Reg #: ELE 26 -152C [ELPRMT] ELC Permit 10/26/200( $80.30 LIC 4443 [TAX] 8 %State Surcharge 10/26/200( $6.42 SUP SOIOS Total $86.72 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 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: Permittee Signature: 11( 1 Q '( -7,dy , 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. • . W 25. 2006 1: 31 PM No. 2166 P. 1/2 Clcal remit Application - .,, i (k 01•1:1( I•: t SI: O:\I.1 - • City of Tigard , V r trcd Q r.:N P DatrIB . r � A! . 167 9U I Permit No.' 0. ,/. — oar '0 13125 SW Hall Blvd., Tigard, OR 97223 ' Plan Revie Phony 503.639.4171 Fax: 503.598.1960 '"' i . Dat • Other Permit: Inspection Line: 503.639.4175 rl q 5 1 ;1 'f J. D ateRoa d y/8y, rmiev ® See Pogo 2 for Internet: WWW,ci.tigard.or.us Qv `' Notifed Method: /j I Supplemental infotmanna g'::b }p. //. ,;. �.:.. \y °M?. L.• �V, � w'F,94. n.: n ..•. 7 • r.1, e� . .::.. , k:F .Xr.V.I c:*, ;??„ ' '•;y u _ �.'ri* "� •. � r'.tk : ° r p. '{ ';i;i aY: , ' �.C ..1t:..: r 1 • ,.i, �•r•,; p . ., . ,..I.,. ? a r; ❑ New construction , _ o /ilbr len/te11"ttuAUt1i 1 I Please check all that apply: El Demolition ❑ m ❑ Service over 225 amps, com'l Hazardous location Other: �y �g� .:77, .., : "x::..�: ❑Servic over 320 ant - mtin Buil ..�.. .;,yt•+Yi•; T w^I'� s „�rY��r� r ti' Y � g' dn$ OVer 10 0 S 3 ��. ,� a" ,,+ .1.. - u�r�, + h� , =;p•' gi �•..�:•.� Ps ,00 Q. ft, ?e� M1 /. rya. a . Y ii it- '.'.., , y ... w : � -.y. ••��i`.3."" ' ;'. �.£ ��- �N�TKU.r °;�C.�; �?rf'�:;;�.,;;t�< oft- and 2- Samilydwellings 4 or more new residential - and 2 family dwelling ❑ Commercial/ industrial ❑ Accessory building • ❑System over 600 volts nominal units in one structure ❑Building over three stories ['Feeders, 400 amps or more El Multi - family ID Master builder CI Other •,,� la: Y.- +,� � — . ❑Ocalpant load over 99 persons ❑Manuletured structures or •... , :•. hfW!.. . . ` - AZ'�O �: �s + te,1 .' 1ze ❑E t tin r . ,� :.,. �a;;:�� . � "v - -� +, gress/l•Bh 8 lan RV park P Job no.:50839 Job site address: p g6 5 41,44 ❑Realth•care facility []Other: Submit 2 sets of plans with any of the above. City/State/ZIP: / / q 0 a( — . The above are not applicable to temporary construction service. . Suite/bldg. /apt. no.: l Project name: : i`° - ,? :. :' y rfj?'. : . ?` ?.. t>::7, . i41; nerortmlon I Q 1 S - Todd I .. Cross street/directions to job site: New residential single - or multi -family dwelling unit. Includes attached garage. 1,000 sq. f. or less 145.15 4 Subdivision: • Lot no.: 11 II I I - H • Tax map /parcel no.: Limited energy, residential i.x;f: L'E .., •• Lxi]s�P a sir• '' `�- ii. .'' 3 '/L�i•+.n `' ,�i t9i�3 ' -• manufactured , modular • Services or feeders installadon, alteration, and/or relocation II 80.30 `a _ 'r vA• 14 •7r.:•:TaF,, ' r rc'iciyr -rt:s ! 'r r —© tp� 5 ������g 3' 4 a r ":ec ?:? . �,.k;.�%=L.r:-' -,. =-� -: 1,7 �'.,;r ... . 201 amps t0 400 amps 106.83 � .,. .Y' d�'o��i(�;;i,}�;. ;•e e��,�,- •�r ' •it.�n� it �• 4 -. •.�F-• v�� ' 401 amps to 600 amps 160.60 2 • • Name: 0 , , / I 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: Q� . Temporary services or feeders Installation, alteration, and/or " Phone: a- �ot'00 D F ( ) relocation 200 amps or less 66.85 1 1 Owner installation: This installation is being made on property that I over which is not 201 amps to 400 a 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: Dare: �} ,� � _ Breech circuits - new, alteration, or extension, per panel i; ,. : � ' a; xf :e 1 ` u_ ; . r + t l� ry A Fee for branch circuits with service or feeder fee. each Business name: branch circuit 6.65 2 B. Fee for branch circuits Contact name: without service or feeder fee, Address: each branch circuit 46.85 2 Each add'I branch circuit 6.65 _ 2 City /State/ZIP: Miscellaneous (service or feeder not included) Phone: ( ) — I P ( ) Pump or irrigation c 53.40 2 Sign or outline lighting 53.40 2 E -mail: Signal circuit(s) or limited- r s 6i:� r. �,S .. . „n _ 7u54 6 ; 'M alteration, or PA� � .;n'µ ^.� .: ,; ,`�m.'�!'74'x; ";. 'f ,: : •'• � I i � : �Q • '' ; ." ,. .. . ;-.�y ;.. ^,'�.' . ,r' ,•, ,T ;.- N'� ";i£waZ'i energy panel a extension. Describe: Page 2 2 Businesi Reds Electric Company • Address 2002 SE Clinton Each additional Inspection over allowable in any of the above Portland, OR 97202 Per inspection 62.50 City /Sta (503)233-6467 Fax (503)233 -1281 Investigation per hour (I br min) 62.50 Phone: ( CCB# 4443 Elec. Lk Supry Lic.# 5010-S Industrial plant per hour 73.75 Y ) }''... A: , (:: ta [„I.- /n..ftf��'00'r,`(' '�, ��r:.,A •'�,.:42*2 1 Subtotal W - ZO . Suprv. Electrician signature, required: / 6.3 -. � Plan review (25% of permit Bee) . Print name: S W � • r e l E...5 _ Date: A V Z 6,706 State surcharge (8% ofpermit $c) 6 . (./ TOTAL PERMIT FEE "I P • '7 4 Authorized signature: This permit application expires If a permit isnot obtained within 180 days after it has been accepted as complete Print name: 4 A I Date: ' e be Fee methodology ra set by T,i- Ci Baitding Industry Service Board 1: 18ulldisg \Pa,miuIELC.PamiWpp.doe 17/07 s owed _ - ,a- M046157(10'071COM/W® CITY OF TIGARD . BUILDING DIVISION PERMIT #: ELC20t)5 00610 13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 10/26/2006 Phone: (503) 639 -4171 ��e �� fllII\ Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 1/12/2007 TIME: 7:04AM PAGE: 40 SITE ADDRESS: 10865 SW PARK ST • CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: MITCHELL. DESCRIPTION: 200amp service. 11/06/06: Added (1) 200 amp for garage panel. 111/3/2006 ADD 9 branch circuits. OWNER: MITCHELL, GARY PHONE #: 503. 522 -6608 CONTRACTOR: REDS ELECTRIC CO INC PHONE #: 503 - 233 Inspection Request Scheduled For: Date: 1/12/2007 Pour Time: Code # Inspection Description Confirm # Contact # Message 199 Electrical final 042015.01 503-522 -6608 N Corrections/Comments/Instructions: (CP PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: b4(44) Date: 1 i Z V 7 Phone #: (503) 718 VIA CITY OF TIG,ARD - 2, • BUILDING DIVISION PERMIT #: ELG2006 00610 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/26/2006 Phone: (503) 639 -4171 V1; l�l Inspection Requests (24 Hrs.): (503) 639 -4175 F: INSPECTION WORKSHEET FOR DATE: 11/22/2006 TIME: 7 :03AM PAGE: 44 SITE ADDRESS: 10865 SW PARK ST CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: MITCHELL DESCRIPTION: 200amp service. 11/06/06: Added (1) 200 amp for garage panel. 11/13/2006 ADD 9 branch circuits. OWNER: MITCHELL, GARY PHONE #: 503 -522 -6608 CONTRACTOR: REDS ELECTRIC CO INC PHONE #: 503-233 -6467 Inspection Request Scheduled For: Date: 11/22/2006 Pour Time: Code # Inspection Description ► - irm # Contact # Message 199 Electrical final 040136 -01 503-522-6608 Y Corrections/Comments/Instructions: ■ Co • PerivIO - c. ) ‹.0. 6t1160A. 6E W6‘ VA141--1 a v �Y PM ti tN G - cols& , (AL5 16•Pf .0 i 134) utms. d YC iire b tzsmh - - W4 RfArat. 'OA - bfF 40a-. sS\) et is Xw Q on this report shall be corrected and an Inspection requAst made within 20 calendar days per OAR 918- 271 -0030 ❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS FAIL XCALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: G — e �O� L ' � Date: I t • 2-14 D Phone #: (503) 718- 2441 CITY OF TIGARD •, BUILDING DIVISION PERMIT #: ELC2006 -00610 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/26/2006 Phone: (503) 639- 4171I�I Inspection Requests (24 Hrs.): (503) 639 -4175 .' "__.. INSPECTION WORKSHEET FOR DATE: 11/17/2006 TIME: 7 :01AM PAGE: 23 SITE ADDRESS: 10865 SW PARK ST CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: MITCHELL DESCRIPTION: 200amp service. 11/06/06: Added (1) 200 amp for garage panel. 11/13/2006 ADD 9 branch circuits. OWNER: MITCHELL, GARY PHONE #: 503-522-6608 CONTRACTOR: REDS ELECTRIC CO INC PHONE #: 503 - 233.6467 Inspection Request Scheduled For: Date: 11/17/2006 Pour Time: Code # Inspection Description Confirm # Contact # Message 199 Electrical final 039970.01 5032336467 N Corrections /Comments/ Instructions: NO bo w Q • ❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ACCESS 'FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: Date: I — r' 7 — 4 a Phone #: (503) 718- CITY OF TIGARD ELECTRICAL PERMIT PERMIT #: ELC2008 -00610 COMMUNITY DEVELOPMENT , DATE ISSUED: 10/30/2008 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 2S 103AC -07000 SITE ADDRESS: 12955 SW 113TH PL ZONING: R -4.5 SUBDIVISION: FONNER WOODS LOT : 006 JURISDICTION: TIG PROJECT: GOHIER Project Description: (2) branch circuits for a/c and hot tub. 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: 1 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: PIERRE GOHIER OWNER 12955 SW 113TH PL TIGARD, OR 97223 Phone: Contact #: FEES Description Date Amount Reg #: [ELPRMT] ELC Permit 10/30/2001 $53.50 [TAX] 12% State Surchar 10/30/2001 $6.42 Total $59.92 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 e - ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 -0. -0010 thr. •h OA: •52- 001 -0100. You may obtain copies of these rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344. Issued : • Permittee Signature: / 1 a S2.. OWNER INSTALLATION ONLY ��99 The installation is being made on property I own which is not inten. d for sale, lease, or rent. OWNER'S SIGNATURE: - ` : - DATE: 4% 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 FOR OFFICE USE ONLY Received G'� A o ,y'I O City of Tigard Received • Permit No.: G f�� , 'C�/ 1 114 q 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review ' C • Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit: T 1 G A Ii D Inspection Line: 503.639.4175 Date Ready /By: J�uri la See Page 2 for Internet: www.tigard - or.gov Notified/Method: I ( e. Supplemental Information TYPE OF WORK PLAN REVIEW Please check all that apply (submit 2 sets of plans w /items checked below): N ew construction ❑ ❑ Addition/alteration /replacement ❑ Service or feeder 400 amps or more ❑ Building over three 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 installations. buildings. ❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system. iA t ❑ Addition of new motor load of ❑ "A ", "E ","I -2 ", "1 -3 ", k 100HP or more. occupancy. Job no.: Job site address: \ a9 55 6 11 ❑ Six or more residential units. ❑ Recreational vehicle parks. ❑ Health -care facilities. ❑Supply voltage for more than Cit /State /ZIP: ("),P..5 r I ❑ Hazardous locations. 600 volts nominal. Suite /bldg. /apt. no.: Project name: v ` ‘ ❑ Service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to job site: Description 1 QtY. 1 Fee. 1 Total 1 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'I 500 sq. ft. or portion 33.40 1 Tax map /parcel no.: Limited energy, residential 75.00 2 * ` DESCRIPTION OF WORK t (with above sq. ft.) tt \ ` V�C�O V - +Q\ Limited energy, multi -family 75.00 2 """/// residential (with above sq. ft.) /� J / ,, Services or feeders installation, alteration, and/or relocation Vt v. ~ " f" I C Ca vvy ( - r 55or 200 amps or less 80.30 2 / ` / PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2 Name: Y l nF p � L 1, 401 amps to 600 amps 160.60 2 +I 601 amps to 1,000 amps 240.60 2 Address: `a J ` l SS 6u) t 1 3 e ' Over 1,000 amps or volts 454.65 2 � City /State /ZIP: _ `1 {� Temporary services or feeders installation, alteration, and/or \ G�( f 1 relocation Phone: (5 r 7Q ? lass Fax: ( ) 200 amps or less 66.85 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, leas Ten hanfe, f ording 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 ❑ AP LICANT ❑ CONTACT PERSON above service or feeder fee, 6.65 2 each branch circuit Business name: B. Fee for branch circuits Contact name: without service or feeder fee, first branch circuit i 46.85 1 K 2 Address: Each add'I branch circuit 6.65 , .6 " 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 - ��� /J energy panel, alteration, or Address: y /`/ extension. Describe: Page 2 2 City /State /ZIP: Each additional inspection over allowable in any of the above Per inspection 62.50 Phone: ( ) Fax: ( ) Investigation per hour (1 hr min) 62.50 CCB Lic.: Electrical Lic.: Suprv. Lic.: Industrial plant per hour 73.75 ELECTRICAL PERMIT FEES Suprv. Electrician signature, required: Subtotal: Print name: Date: Plan review (25% of permit fee): ../ State surcharge (12% of permit fee): (0 , 47- J Authorized signature: TOTAL PERMIT FEE: I V This permit application expires if a permit is not obta Within 1 Print name: f I e P ; era Date: 1 n �f, /1��� days after it has been accepted as complete. r tJ * Number of inspections allowed per permit. I:\Building\Permits\ELC - PermitApp.doc 05/23/06 440- 4615T(11/05 /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 $75.00 system (SEE OAR 918- 309 -0000) 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* ❑ Protective Signaling ❑ Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations 1 \ Building \Permits\ELC- PermitApp.doc 03/23/06