Permit CITY OF TIGARD ELECTRICAL PERMIT
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PERMIT #: ELC2009 -00063
COMMUNITY DEVELOPMENT DATE ISSUED: 2/17/2009
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1S134CA
SITE ADDRESS: 11125 SW 119TH AVE ZONING: R -4.5
SUBDIVISION: PANORAMA NO.2 LOT: 01$ JURISDICTION: TIG
PROJECT: FABIAN
Project Description: Grounding for new water service.
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: SIGNAUPANEL:
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:
GOLDA FABIAN METROS BEST ELECTRIC
11125 SW 119TH AVE P.O. BOX 30075
TIGARD, OR 97223 PORTLAND, OR 97294
Phone: Contact #: PRI 971 - 563 - 9418
FAX 503 - 262 -8251
FEES
Description Date Amount Reg #: ELE C430
[ELPRMT] ELC Permit 2/17/2009 $46.85 LIC 147298
[TAX] 12% State Surchar 2/17/2009 $5.62 SUP 4619S
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 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: ay ,\..5j_ k in Permittee Signature: S Q ¢ t e' Q 1 C�\
V�
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.
Fab 16 09 04:35p Casey's Plumbing 5032628251 p. 1
r Electrical Permit Application RECEIVED FOR OFFICE USE ONLY
City of Tigard Received p
Date/By: a • l.7 . o 1 Permit No..fl ? ^y�,Q . /'K(_
13125 SW Hall Blvd.. Tigard, OR 97223 FEB 17 2009 �J l v. 1 ` 1`v
Plan Review
G Phone: 503.639.4171 Fax: 503.598.1960 Date/By: OdtcrPcrrait: (n 009.002-,..
T I GA RD Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: ions. H See Page 2 for
Internet: www.tigard- or.gov
BUILDING DIVISION Notified/Method: ! 1 6 s 1 Supplemental Information
TYPE OF WORK ul!• PLAN AN REVIEW
ew construction ❑ Addition/alteration/replacement Please check all that apply (submit 2 sets of plans ‘v/items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
D emolition ❑Other: where the available fault current El 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
and 2- family dwelling ❑ Cornmerciallindustrial ❑ Accessory building amps for ell otherinvallations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION
O Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E", "1 -2 ", "1 -3 ",
Job no.: Job site address: `l 1 \ Q� 1 OOHP or more. occupancy.
1 1 1 ` 0 Six or mom residential units. ❑ Recreational vehicle parks. City/State/ZIP: y �y „ Q c\-1 �1 1 Ot � ❑ Health -caze Frcilities. 0 Supply voltage for more than
t ^ �t t 1 N El Hazardous locations. 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 J Qty. i Fee. ] Total I •
New residential single- or multi - family dwelling unit.
c ane 1710 Los-%--C._:2_ Includes attached garage.
Subdivision: l - _'cY" Lot no.: 1,000 sq. ft. or less 145.15 4
Tax map /parcel no.: Ea. add'( 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
���..,��, f ��t , Limited energy, multi - family 75.00 2
-S -*r AN l' c 1� c v _ residential (with above sq. ft.)
Services or feeders installation, alteration, and /or relocati n
200 amps or less 80.30 j 2
/
PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
Name: L (3 ft C1 401 amps to 600 amps 160.60 2
T i . Over
454.65 2 1,000 amps or amps
olts 240.60
2
Address: 5
1\�2� ..�� � t a t �.
City /State/ZIP: �cAr ) ciE 77:2) 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 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Owner signature: Date: Branch circuits- new, alteration, or extension, per panel
A Fee for branch circuits with l
5 APPLICANT ❑ CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: ive r i2 si- C LQC-Y iC . B. Fee for branch circuits
Contact name: without service or feeder fee, 1 46.85 2
first branch circuit
Address: S'—. Each add'l branch circuit _ - 6.65 2
Q ^ _ - Lj Miscellaneous (service or feeder not included)
City /State /ZIP: { �}�� 4 (u ( a { "l � Each manufactured or modular
90.90 2
/ dwelling, service and/or feeder
Phone: (C01 1 ) 51��3 . y i s Fax: : ( ( (s2-- 2-S1 Reconnect only 66.85 2
E -mail: Cs7a- 4- r_ e O t', .vv\ o l`(1 C , . C,f*T1 Pump or irrigation circle 53.40 2
CO RAh Sign or outline lighting 53.40 2
Business name: ���""� , , 1 , Signal circuit(s) or limited -
eArV ,'S't CA v y r ; C._ energy panel, alteration, or
Address: (, ij� - ) x 5 .") extension. Describe: Page 2 2
City/State /ZIP: - u 1 � . f _ C .4 Each additional inspection over allowable in any of the above
1 Per inspection 62.50
Phone: ql 1 G- t - ciL1 t g x: (.
Fa ) c6 a Si Investigation per hour (1 hr min) 62.50
CCB Lie.: 1 t.. ", S Electrical Lie.: 0,4 ' Suprv. Lie.: L15i J - i e C Industrial plant per hour 73.75
ELE CTRICAL PERMIT FEES
Suprv. Electrician signature, required: 2 j Subtotal: L e,
} �' Plan review (25% of permit fee):
Print name: O 1 , A Date:
k .:r YiTo State surcharge (12% of permit fee): S. 6 2
Authorized signature: k G ; • t14 ; .1C TOTAL PERMIT FEE: ` � 2- 4
Print name: +l i �� C) j�1
This permit application expires if a permit is not obtained within 180
r (, �rl' kE Date: � � days after it has been accepted as complete.
• Number of inspections allowed per permit.
l\ BuildingtPennirs \ELC- PermitApp.doe 05/23/06 440 - 16151'(11 /05 /COM/WEB
CITY OF TIGARD
410
BUILDING DIVISION PERMIT #: EL02009 0U06
1:3 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: /17 /2009
Phone: (503) 639-4171 Jhp11 l)(
Inspection Requests (24 Hrs.): (503), 639 -4175
INSPECTION WORKSHEET FOR DATE: 2/10/20 TIME 0AM PAGE: 25
SITE ADDRESS: 11125 SW 119TH AVE CLASS OF WORK:
SUBDIVISION; PANORAMA NO.2 LOT #: t91'S TYPE OF USE:
PROJECT NAME: FA13IAN
DESCRIPTION: Grounding for new water seiwic:e.
OWNER: FABIAN, EOLDA PHONE #:
CONTRACTOR: METROS BEST ELECTRIC PHONE #: 971-563-941B
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Inspection Request Scheduled For: Date: 21812009 • Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical find 080580-01 503 -253 -0030 N,
Corrections/Comments/Instructions:'
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in -AS (. PARTIAL. APPROVAL 0 CANCEL 0 NO ACCESS
n FAIL /J Ifs CALL. FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED •
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Inspector: Date: V V (9 Phone # : (503) 7 18-