Permit ELECTRICAL PERMIT
CITY OF TIGARD
COMMUNITY DEVELOPMENT PERMIT #: ELC2008 -00197
DATE ISSUED: 4/4/2008
7t9 /R115 . 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S1 12C B -07700
SITE ADDRESS: 15143 SW KENTON DR ZONING: R -7
SUBDIVISION: ASHFORD OAKS NO. 2 LOT : 091 JURISDICTION: TIG
PROJECT: TAKAHASHI
Project Description: (3) branch circuits for kitchen remodel.
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: 2 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:
TETSURO & AKEMI TAKAHASHI OWEN WEST ELECTRIC
15143 SW KENTON DR 8310 NW REED DR
TIGARD, OR 97224 PORTLAND, OR 97229
Phone: Contact #: PRI 297 - 6375
FAX 503 - 297 -6375
FEES
Description Date Amount Reg #: ELE 26 -398C
[ELPRMT] ELC Permit 4/4/2008 $60.15 LIC 29492
[TAX] 12% State Surchar 4/4/2008 $7.22 SUP 2885S
Total $67.37 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- 0 thro • ,h 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: ( -�XX / ►f 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 INS ALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: i i - it P. II •
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.
Electr Permit Application t L r _ . { w' FOR,OFFICE USE ONLY - 5 w
5 4 „ " Received
p 1 k 0 % C of Tigard DateB : �� j _Jr Permit No.: e� „r1 /g -"D�/
dd t �
” v 1 31 25 SW Hall Blvd., Tigard, OR 97223 Plan Review
• , R- ;1 Phone: 503.639.4171 Fax: 503.598.1960 DateBy: Other Permit:
r
Itt q Inspection Line: 503.639.4175 Date Read /By: t ® See Page 2 for
GIAR•D �r
u3!a'+'+S� Internet: www.tigard- or.gov Notified/Method: / t,p. Supplemental Information
❑ New construction Addition /alteration /replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ 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 A
❑ Emergency system. larger separately derived.system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "I -3 ",
Job no.: Job site address: ( LA 3 .5 (,v [) d y , D ), 100HP or more. occupancy.
❑ 0 or more residential units. Recreational vehicle parks.
City/State/ZIP:
❑ Health -care facilities. 0 Supply voltage for more than
❑ Hazardous locations. ! �� CU/ 600 volts nominal.
Suite/bldg. /apt. no.: Project name: ❑ 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 . . ' (w a sq. ft .)
/ � h � � Limited energy, multi - family 75.00 2
1. At .� ✓C.
1
N . /714 residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER '❑ 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 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 • • 0 _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, 46.85 2
first branch circuit
Address: Each add'I branch circuit 6.65 9,, 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: (..' t /N - " Signal panel, or limited -
energy panel, alteration, or
Address: f3 A9 e p o 0 1 bt' l extension. Describe: Page 2 2
City/State /ZIP: -fi Ly4,\ a,� 7 �.i Each additional inspection over allowable in any of the above
_ Per inspection 62.50
Phone: (5 2 �p 7 — , 33 7 S Fax: ( ) 5 �.0 Investigation per hour (1 hr min) 62.50
CCB Lic.: /. / p'c f. /� f Electrical) Lic.'/ -37S- Suprv. Lic.:/�ejrc5 Industrial plant per hour 73.75
/ /)� ELECTRICAL PERMIT •FEES' 0 0 ,
Suprv. Electrician signature, required: G.0 /1 //J � Subtotal: L f 5
Print name: 'n c - owe_ Date• r�S. Plan review (25 %ofpermit fee): —� —
�/ �`�/ State surcharge (12% of permit fee): 7 , PO-
Authorized signature: TOTAL PERMIT FEE: Le ''''7, 3
This permit application expires if a permit is not obtained within 180
Print name: Date: ` �--Q� days after it has been accepted as complete.
• 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 WORtONLY: .
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
I: \Building\Permits\ELC- PermitApp.doc 03/23/06
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2008- 00197
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/4/7008
Phone: (503) 639 -4171 Z1; 14111' Inspection Requests (24 Hrs.): (503) 639 -4175 —.
INSPECTION WORKSHEET FOR DATE: 4/7/2008 TIME: 7:01AM PAGE: 8
SITE ADDRESS: 15143 SW KENTON DR CLASS OF WORK:
SUBDIVISION: ASHFORD OAKS NO. 2 LOT #: 091 TYPE OF USE:
PROJECT NAME: TAKAHASHI
DESCRIPTION: (3) br::,nch circuits for kitchen remodel.
OWNER: TAKAHASIII, TETSURO 8, AKEMI PHONE #:
CONTRACTOR: OWEN WEST ELECTRIC PHONE #: 297 -6375
Inspection Request Scheduled For: Date: / 4/7/2008 Pour Time:
Code # Inspection Description Con irtii Contact # Message
120 Electrical rough -in 067989 01 503 - 2.97 - 6375 N Y
Corrections /Comments /Instructions:
1 '"
L e
Ai PASS ❑ PARTIAL APPROVAL . ❑ CANCEL n NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: .y NUS Lt Date: Li • 1 . C A Phone #: (503) 718- °OIL
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