Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELC2009-00028
t• DATE ISSUED: 1/20/2009
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1S136AA -02201
SITE ADDRESS: 11153 SW 65TH AVE ZONING: R - 4.5
SUBDIVISION: LOT : JURISDICTION: TIG
PROJECT: KESSLER
Project Description: Reconnect.
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: 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: 1 SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
JULES KESSLER PACIFIC NORTHWEST ELECTRIC INC
8700 SW 26TH STE H PO BOX 310
PORTLAND, OR 97219 OREGON CITY, OR 97045
Phone: Contact #: PRI 503 - 657 -1188
FAX 503 - 722 -9058
FEES
Description Date Amount Reg #: ELE C6
IEL,PRMT] ELC Permit 1/20/2009 $66.85 LIC 162893
(TAXI 12% State Surchar 1/20/2009 $8.02 SUP 50895
Total $74.87 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: �C ,gy ful _ ttO jhb Permittee Signature: �QQ W �Q,(A. ()n __ vvp """ OWNER INSTALLATION ONLY 1
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.
.. 01/ 0/2009 11:19 50372290513 V I j CIFIC NW ELECTRIC PAGE 01/02
Electrical P e r m i t Application FOR 01-T1(1.:. l S E O N l ,'
City of Tigard ' 1 ' '' ` (' ./ Received
Permit No.:
131 SW Hall Blvd, 'Tigard, OR 97223 ' 2 - ewer; ' m Phone: $03.639.4171 Fare 5 OF TIGAR i 1" other Permit:
1'1c. i Line: 503.639.4175 ' Si . (,ye g
S See Pape zlbr
Internet: www,l . -or, g tJ l f n! r , I (v, �� } Jcthod: Supplemental IafinmatMn
° _rvt►E tit' *tall -
I'ILAN: REVritvv
❑ New cotlst illcllon Ad dition /aIteTation/11C)llacement Please check all that apply (mbinit2 acts of plans w/itcros checked below):
O Demolition ( D Service or feeder 400 mats or more El Building over three stories.
.
where the available fault current El Marinas and boatyards.
.. ' - A'l`'lx[ �71' C3F'.�NtrJiilt4'1 lull ::• . ' .. =mesh 1 0000 amps at 150 molts a El floating buildings. , - and 2 fAm1 ' dwelling ❑ CO1Ltt11cTC18l/1[IdIL4t7ia� 0 /�CCe4 ld - less to ground or exceeds 14.000 ❑ Commercial -use agricultural
Multi-family ❑ Master I1ui ld cr ❑ other. � � amps ibr 7111 c>ther ;natnllaUmr. < IruildinAe,
er. ❑ Fire pomp. ❑ Installation of 75 KVA or
1
:I11l3 'SC1 r` `:t 'SATT�1'II1::;A146 LOCA'1'lY' 13 Emergency larger sepnrntcly derived system.
. ❑ Addition efncsv motor load nf ❑ "A ","E ".- I- 2 ",••t_3 ",
Job no.: Job site address: 1 I ' i „, /n 5 t t o* eccr+IAnoy.
❑ Six or mom redid itial u 17 Recreational vehicle parks.
City /St ite/ZIP: 7'1 J n .rJ , O 2 ❑ Health -care facilities. 0 3teppiy.mltngc for more th m
X14 DHazttdvus loeatiom, 6001m1tx nominal.
Suite/bldg. /apt. no: Project. name: 0 Service a feeder 600 Amps or more.
Gross street/directions to job site:
K'ldt'� 1t
.1 e 7e tml
New residential single- or rnniti- fnmily dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or loss 145.15 ` 4
Tax map/parcel no.:
r Bo, add? 500 sq. R. or portion 33.40 1
Limited residential 75.00 2
AB3Crt ... :a�fi WORK .............. ..
" � p ,�
Limited energy, rnr 1tf- fandly — -
4 D 0 ) ee L_I .-� 1 / r -'1 ' ' CI residential (with arrow eL 75.00 2
)
+ �. 1 t� Services or feeders instalintiolu, n n, and /or relocation
200 maps or less 80.30 • 0 14 2
. . 1:1' . /ItOkElitly C1WPiigtt • ,..:. 0 . TENANT
201 mttpx to 400 amps 106.85 2
Name: 401 amps to 600 amps 160.60 2
601 amps 10 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: ( ) j Fax: ( ) 200 romps or less 66.85 1
Owner Installladan: This installation is being made on property that 1 owls which is not zn 1 amps to 400 9sapr 100,30 2
intended for salty lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 13175 circuits circuits 2
Owner signature Branch circuits - new, alteration, or extension, pc�anrl ..
A Fcc for branch circuits with
. , ` Er APPI CAS t' 0' cbNTAt Pfl oN above service or feeder fee. 6.65
each branch circuit 2
13us iTless na me 41 U /I 1 D Lam. b l 13. Fee for branch circuits
Contact name: �` S 0_71c., without service or feeder fee,
J a . i ,( .' fat branch circuit i 46.85 2
Address: Each add1 branch circuit 6.65 ( 2
nelsea1taneoav ( service or feeder ark included)
City/State/ZiP: Each manufactured or modular
1 dwellin service and/or feeder 90.90 2
Phone: ( ) Fax : ( ) '
Reconnect only 66 -85 2
E -mai : A L� 'l;,,. * ' • g • ( c'p 1'. T Pump or irrigation circle 53.40 2
.:. IGd'trt`l'�lafc"Y ttl ' S'
" :. : r or outline lighting 53 2
Business name: _ G n 1 o 1 sr pet tti a t or alteration. o r
limited-
-.J .; C- crime/ ttncl, alteration. , o
Address: pc, ,, -7z/ b extension Describe: ra 2
( e2
Cit y /St ate/ZIP: Q( . _ (2 ._ q i D cis Each additional inspection over allowable in airs of the nbmre
.-� inspection
Phon Fa x: - investigation i vesti pecti n per hour (1 hr min) 62.50
CCB tic,: 3 (9 S1 3 Electrical tic.: (L L, Suprv. 4S Industrial plant per hour 73.75
•EX.F.ICr'1U cAt,i 'PERM1r.jrt S,, :
Suprv. Electrician signature, required: \ r
i - ' = d• Subtotal:
Print name: } b .� , : Plan review (25% of permit fee):
iiL state surcharge (1244 of permit 1 fecy rT
Authnrizcd signature: di' -. ° � / / � , 1 , o7Ai.l;; , 1t M'l;'
PERMIT : 2?
Print Haltom: f 'n^' Date. 1 r Z A .-, 6 /J This permit application expires if a permit Is not obtained within 180 s.S
CITY OF TIGARD.
B�.JIL3ING DIVISI ®N PERMIT #: E c..2009 tjOff:l3
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 1/201200
Phone: (503) 639 -4171 . I�I+�
Inspection Requests (24 Hrs.): (503) 639 - 4175.'
INSPECTION WORKSHEET FOR DATE: 1/26/2009 TIME: 7.00AM PAGE: 10
SITE ADDRESS: 11163 SW f r;TH AVE CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: KESSLER
DESCRIPTION: Remu,ect
OWNER: KESSLEE', JULES PHONE #:
CONTRACTOR: PAtr'INC NORTHWEST ELECTRIC INC PHONE #: :503
Inspection Request Scheduled For: Date: 1/260009 Pour Time:
Code # Inspection Description Confirm # Contact # Message
11?D Electrical service 0130011 -01 &)3 969 - 839 N
C \�arFe cit9 F e n`s
ns /Co�pments / ctions:
` Q .3 `S c ss b
)o NOT ca.iir i0 06 wica • ("at ko 1/431
J 0 `
I S c-1 e)( ii9A4R4) fink
fs\00 Vita i(- i.,
■
, \ 1
1 PAS' ❑ PARTIAL APPROVAL ❑ CANCEL PI NO ACCESS
n FA n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: &Th 'V 0 6 Date: 1 - 2b 1 Phone #: (503) 718 - 2-11‘
._ .
CITY OF TIGARD
_,,
BVILbING DIVISION PERMIT #: k71.C2009-00028
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11200009
Phone: (503) 639-4171 koNit
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE:. 112312009 TIME: 7 PAGE: 19
SITE ADDRESS:. 11 153 'SW 66IFI AVE CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: KESSLFR
DESCRIPTION: p,„ ect ,
OWNER: ITSSLER, *JULES PHONE #:
CONTRACTOR: PACIFIC NORTHWEST ELECTRIC INC .--. 1- .. ■ PHONE #: 503-657-11M
\i OThN
eLA clli zi-v-to's
Inspection Request Scheduled For: Date: 1n312009 Pour Time:
Code # Inspection Description Confirm # Contact # Message
195 lose. inspection 079951-01 503.969- 8839 N Y
Corrections/Comments/Instructions:
k).>./(.1 IlkaT 141\6 _.,
w7 Iva \)i I
k
O PASS X PARTIAL APPRO ' L 0 CANCEL 0 NO ACCESS
O FAIL _ A e ' SPECTION 111 ADDITIONAL FEES ASSESSED
Inspector: 6.---- N t.ig CE' Date: I - 2 3 Phone #: (503) 718- Itirt•
/