Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2009 -00038
11111 c COMMUNITY DEVELOPMENT DATE ISSUED: 1/27/2009
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 2S111CC
SITE ADDRESS: 10200 SW HIGHLAND DR ZONING: R -7
SUBDIVISION: SUMMERFIELD NO.4 LOT : 221 JURISDICTION: TIG
PROJECT: WARD
Project Description: Panel change. Job NO. J42926
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: 1 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:
CAROLYN WARD WEST SIDE ELECTRIC CO INC
30853 SW ORCHARD DR 1834 SE 8TH AVE
WILSONVILLE, OR 97070 PORTLAND, OR 97214
Phone: 503 - 582 -1200 Contact #: FAX 503 - 231 -9987
PRI 503 - 231 -1548
FEES
Description Date Amount Reg #: ELE 26 -135c
[ELPRMT] ELC Permit 1/27/2009 $80.30 LIC 13306
[TAX] 12% State 1/27/2009 $9.64 SUP 4654S
Total $89.94 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 - - forth in OAR 952 - 001 -0010 through OAR 952 -001 -0100. You may obtain copies of these rules or direct questions to OUNC at
503.246.6-•9 or 1.80■. . .'4.
/
Issued :y:
y: �� � . Permittee Signatur •
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: � �� l 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.
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City of Tigard Recei ed 9- 3 V ` 'r 13125 SW Hall Blvd., Tigard, OR 97223 Da clay: Q % Permit No.. �' L� S ' Phone: 503.639.4171 Fax: 503.598. 2 7 2009 Plan Review 3y:
503.639.4171 i Date/13y: Other Permit:
" ` "r"`' Inspection Line: 503.639.4175 Dale Ready/By:
ati AItD yP 0 Sec Page 2 for
Internet: www.tigard or.gov Notilied/Method: /(a Supplemental Information
TYPE O
CITY OF TIGARD
`I A'
T }� {�`t V � , ! � G DIVISION PLAN REVIEW
❑ New construction
M. AddI11017 /illl('rari0r1 /replacen7C(tt
Please check all that apply (submit 2 sets of plans w/items checked below):
❑ Service or feeder 401) amps or more ['Building over three stories.
❑ Demolition 0 Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at ISO volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
[X1, 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.
0 Addition ofncw motor load of ❑ "A" "li" "I.2" "I.3"
Job no,: °L1'26�' 2_, V Job site address: ) 2 �� . j �) f 1001IP or more. occupancy.
(Y 5 c p ti ( 1'
J ❑ Six or more residential units. ❑ Recreational vehicle parks,
City/State/ZIP: ' ' l �{ L-1 ❑ health -care facilities. El Supply voltage for more than
v j- ❑ f fazardous locations, 600 volts nominal.
Suite /bldg /apt. no.: Project name: 4 (/! ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site:
Description I Qt • I Fee. J 'Total I •
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 (with above sq. R,)
Limited energy, multi- family
Ge /�2. C- v {� residential (with above sq. fl.) 75.00
Services or feeders installation, alteration, and /or relocation
VA PROPERTY OWNER 200 amps or less , 80.30 .ul�. 5 3 2
❑ TENANT 201 amps to 400 amps 106.85 2
Name: C. a \ V\ � 401 amps to 600 amps 160.60 2
Address: (� _ ( f / 601 amps to 1,000 amps 240.60 2
ma . r S� lJ �' t bleu y •i r
x) Over 1,000 amps or volts 454.65 2
City /State /ZIP: ' / t c� Li . (L 0 l'') E 17 0 Temporary services or feeders installation, alteration, and /or
relocation
Phone: (, 03 ) 7 ` ) 1 0 0 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 ❑ 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, 4! 85
Contact name: first branch circuit
Address: Each add'I branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City /State /ZIP: Each manufactured or modular 90.90 2
Phone: ( ) Fax: : ( ) dwelling, service and /or feeder
Reconnect only 66.85 2
E- mail: GLENNC @WESTSIDEELECTRIC.COM Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Business name: WEST SIDE ELECTRIC CO. Signal circuit(s) or limited -
energy panel, alteration, or
Address: 1834 SE 8TH AVE. extension, Describe: Page 2 2
City /State /ZIP: PORTLAND, OR 97214 Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (503) 231 -1548 Fax: (503) 231 -9987 _ Investigation per hour (I hr min) 62.50
CCB Lie.: 13306 Electrical Lie.: 26 -135C Suprv. Lie.: 4654S Industrial plant per hour 73.75
/ ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required:�2 -,..,_. "e- -( l 7 j L - -.
.
t- Subtotal: I 2 0 . 7 ) i,)
Print name: RANDALL ROBERTS Date: j /2 7 /U Plan review (25% of permit fee):
�� Slate surcharge (12% of permit fee): 9j 6 Li
Authorized signature ' -i TOTAL PERMIT FEE: , et , 9 i./
Print name: Date: This permit application expires if a permit is not obtained within ISO
days after it has been accepted as complete.
' Number of inspections allowed per permit.
3 :tnundingSPenniis1ELC- r'enmttpp doe 11512310E 440- 4613r( I do rcomiw En
CITY r TIGARD
BUILDIN DIVISION PERMIT #: ELC2009.00030
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/27/2009
Phone: (503) 639 -4171 A 'II
Inspection Requests (24 Hrs.): (503) 639 -4175 . � . _
INSPECTION WORKSHEET FOR DATE: 2/17/2009 TIME: 7:00AM PAGE: 10
SITE ADDRESS: 10 200 SW HIGHLAND DR CLASS OF WORK:
SUBDIVISION: SLJMME12FIELD NO.4 LOT #: 7 21 TYPE OF USE:
PROJECT NAME: WARD
DESCRIPTION: Pastel change. Job NO. 312926
OWNER: WARD, CAROLYN PHONE #: 503 - 582.1200
CONTRACTOR: WEST SIDE ELECTRIC CO INC PHONE #: 503 -231- 15
Inspection Request Scheduled For: Date: 7.1 17/2009 Pour Time:
Code # Inspection Description - onfirm #•,_ Contact # Message
199 Electrical final a80563-01 503-582-1200 N
Corrections /Comments / Instructions:
K€ wi(Z, d(L WkLA r PAN'TmL. ,
1 C , 3\7_.
t
\ \ \.
/t\ii:\ i
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES.ASSESSED
Inspector: 6---1 1v 66 Date: 2.''11 .°1 Phone #: (503) 718 - 1- 1.11 1
CITY F TIGARD
BUILDM DIVISION PERMIT #: E=LC2009 -UUO38
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/27/2009 -
Phone: (503) 639 - 4171' ,1��lI .
Inspection Requests (24 Hrs.): (503) 639 - 4175 — 4' _
INSPECTION WORKSHEET FOR DATE: 7/3/100!; - TIME: 7:00AM PAGE: 26
SITE ADDRESS: 10200 SW HIGHLAND DR CLASS OF WORK:
SUBDIVISION: SLIMiviERHELD NO.4 LOT #: 721 TYPE OF USE:
PROJECT NAME: WART?
DESCRIPTION: panel change. Job NO. J42926
OWNER: WARD, CAROLYN PHONE #: 503- 582 -1200
CONTRACTOR: WEST SIDE ELECTRIC CO INC PHONE #: 503 - 231.1548
Inspection Request Scheduled For: Date: 2/3/2009 Pour Time:
Code # Inspection Description Con# Contact # Message
,
199 Electrical final \ 080190-1 503.231 -1548 N
Corrections /Comments /Instructions:
H, v6 . Loc'0
•
I
❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL NO ACCESS 1
I
FAIL CALL FOR INSPECTION r TIONBIC FEES ASSESSED
Inspector: �i Iv� w Date: Z'3' Y Phone #: (503) 718 - %
1