Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2008 00386
COMMUNITY DEVELOPMENT
D ATE ISSUED: 7/7/2008
Tlcntib; 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S114BC -04500
SITE ADDRESS: 10496 SW BONANZA WAY ZONING: R -7
SUBDIVISION: RIVERVIEW ESTATES NO. 2 LOT : 082 JURISDICTION: TIG
PROJECT: DIXON
Project Description: Installing (7) 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: 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: 6 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:
KENNETH & KIMBERLEE DIXON OWNER
10496 SW BONANZA WAY
TIGARD, OR 97224
Phone: 503 - 624 -5609 Contact #:
FEES
Description Date Amount Reg #:
[ELPRMT] ELC Permit 7/7/2008 $86.75
[TAX] 12% State Surchar 7/7/2008 $10.41
Total $97.16 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 503.246.66'9 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.
.., Electrical Permit Application ` r �' t ' d olz '''''''..','+'''.-::''.- i 1 - 1c i sl 0
1
C of Tigard Date/B : � 'ermit No.:
V 13125 SW Hall Blvd., Tigard, OR 7 (� � • '
g "
`� Q Plan Review '
Phone: 503.639.4171 Fax: 503.598.1960 \�� Q Date /B : Other Permit:
Inspection Line: 503.639.4175 J r l ate Ready/By: ® pp See Page 2 for
T I G A 12 D: �� o 1® . o tified/Method: MI Su Iemental Information
• - . - - Internet: www.ti g ardor. g ov ' G , 0 ,. P � � �
• TYPE OF WO I A` 4 PLAN REVIEW
Additi replacement
Please check all that apply (submit 2 sets of plans w /items checked below):
New c onstruction
❑ ® P
❑ 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
❑ Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A ", "E ", "I - 2 ", "I - 3",
10OHP or more. occupancy.
Job no.: Dixon Job site address: 10496 SW Bonanza Way
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: Tigard, OR 97224 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: Dixon Kitchen ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: SW corner of Riverwood and Bonanza Way Description 1 Qty. 1 Fee 1 Total 1 •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Riverview Estates 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
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
Limited energy, multi - family 75.00 2
Change lighting, move appliances, move plugs in keeping with remodel. 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: Ken Dixon 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: 10496 SW Bonanza Way Over 1,000 amps or volts 454.65 2
City /State /ZIP: Tigard, OR 97224 Temporary services or feeders installation, alteration, and /or
relocation
Phone: (503)624 -5609 Fax: (503)620 -6825 200 amps or less 66.85 1
Owner installation: This installation is being made on property that 1 own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, o e hang t rding to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
t p Branch circuits – new, alteration, or extension, per panel
Owner signature: _ �� • Date: - 1/7 'o U A. Fee for branch circuits with
❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: B. Fee for branch circuits
without service or feeder fee,
Contact name: first branch circuit 46.85 �/ ' ?5-2
Address: Each add'l branch circuit 6.65 - 5 Ct 2
Miscellaneous (service or feeder not included)
City /State /ZIP: Each manufactured or modular 90.90 2
dwelling, service and/or feeder
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: ,CC pan
Signal circuit(s) or limited-
M t/ energy panel, alteration, or or
Address: 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: g ''''"-----
Plan review (25% of permit fee):
Print name: Date:
State surcharge (12% of permit fee): t U , Li
Authorized signature: a� cw, TOTAL PERMIT FEE: c? 7., ((
This permit application expires if a permit is not obtained within 180
Print name: ���� Date: 7 7 ��� days after it has been accepted as complete.
' Number of inspections allowed per permit. -f.
I:\ Building \Permits\ELC- PermitApp.doc 05/23/06 440- 4615T(I I /05 /COM/WEt3
Information Notice to Property Owners About
Construction Responsibilities Statement
Oregon Law requires residential construction permit applicants who are not licensed
with the Construction Contractors Board to sign the following statement before a
building permit can be issued. [ORS 701.055 (4)]
This statement is required for residential building, electrical, mechanical and plumbing permits.
Licensed architect and engineer applicants, exempt from licensing under ORS 701.010(7), need
not submit this statement. This statement will be filed with the permit.
Please check the appropriate box and complete the following statement:
1 own, reside in, or will reside in the completed structure and my general contractor is:
Name CCB Expiration Date
I will instruct my general contractor that all subcontractors who work on the structure must be
licensed with the Construction Contractors Board.
or
lk I will be performing work on property I own, a residence that I reside in or a residence that I will
reside in. If 1 hire subcontractors, 1 will hire only subcontractors licensed with the Construction
Contractors Board. If I change my mind and hire a general contractor, I will contract with a
contractor who is licensed with the CCB and will immediately notify the office issuing this building
permit of the name of the contractor.
I have read and understand the Information Notice to Property Owners about Construction
Responsibilities contained on these two pages and I hereby certify that the information checked and
completed above is correct and accurate.
KEN, 6 ( Y-t)r./ &e„,..C2,,c4.„,
Print name of permit applicant Signature of permit applicant
7 (7/ 0 8
Date
'7SC_ bwS c.v3
Permit # :FCt.ekr2- O3: Pe01acx)1-W?8o
This form is supplied to building lUc�� ��� � c�Uuv Za Gt
permit offices by the Oregon '' Address: r
Construction Contractors Board, N�;. 4, : %:
as required by ORS 701.055 (6) *'�`''' �'�� �� �
1:5-
7/7/
Issued by: 9:7" Date: //(
This copy to issuing permit office
Os/Ms s/Ms f o C�4vixot eo,J l+eTo 2 G2oN
CITY O F TIGARD Grv��e • �p-4�
ELECTRICAL PERMIT
° PERMIT #: ELC2008 -00386
COMMUNITY DEVELOPMENT DATE ISSUED: 7/7/2008
TI GAR ID; 13125 SW Hall Blvd., Tigard, OR 97223 503.6394171 PARCEL: 2S114BC 04500
SJTE ADDRESS: 10496 SW BONANZA WAY ZONING: R -7
SUBDIVISION: RIVERVIEW ESTATES NO. 2 LOT : 082 JURISDICTION: TIG
PROJECT: DIXON
Project Description: Installing (7) 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: 6 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:
KENNETH & KIMBERLEE DIXON PRAIRIE ELECTRIC INC
10496 SW BONANZA WAY 6000 NE 88T1-1 STREET
TIGARD, OR 97224 VANCOUVER, WA 98665
Phone: 503 - 624 -5609 Contact #: PRI 800 - 573 -2750
FAX 360- 573 -9866
FEES
Description Date Amount Reg #: ELE 37-491C
[ELPRMT] ELC Permit 7/7/2008 $86.75 LIC 60178
[TAX] 12% State 7/7/2008 $10.41 SUP 3562S
Total $97.16 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 r han 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center.
Those rules a set forth in OAR - 001 -0010 through OAR 952 -001 -0100. You may obtain copies of these rules or direct questions to OUNC at
503.246.669 or 1.800.332
Issued By: Permittee
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.
Phone: 503
08/15/2008 15:02 FAX 3605767422
a‘ - �� �i � - 0001 /002
Electrical Permit Application °' "t " ; x ' .., " 4 0 E . ,w k
�. FnR S L1 "a'p f� 1
� .l.a�. �� . liaiL r s .ney t C h u � , . .
'
s, Ci ty of Tigard Y
Received I n � - �
4 , i t a ■ Date/By: Permit No..
, 13125 SW Hall Blvd., Tigard, OR 97223 T ()
• i' - ' ® .•�t:• .639.4171 Fax: 503.598.1960 Date/
By: .-s Inspection Line: 503.639.4175 � U 1 2 008 Plan Review
_ Y: Other Permit:
T I G k Al Date Ready/By lurir. ® See Page 2 for
krt,,,y,o:vr Internet: www.tigard- or.gov , B Notified/Method: Supplemental Information
4 it tn�Kti . :IMEIF�J�l .EI + o �,ai 4t.fi 8} vt -, l : - r 1 n . ('}?, �: gD't
. -� L..l•.t- �t':„. ;�.;w $�f �-� A'* a..,.,:+l..u>.t:<. � J � ����...::::�,x;_ r�
❑ New construction ® Addition/alterati 3 ment 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
.7 N L`y , H �„ r� i"•-s-�' -, 7; t sr• 4*- Fls - ❑ Marinas in and boatyards.
n7' •tE; ii:: -c '� ... � Y „�f� ,fi � M i c - C �+. :Y4 M r • �• 1 i t , � exceeds 10,000 amps at 150 volts or ❑Floating buildings.
� t i'• ' 'ra less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
® I- 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
a `" ri ' i`I'+� 1 u' wvr� .r n , E system. larger separately d enved stem.
s
a: iz. �-.. , iX rt , ,, k y f-u er,s,: Fk /3 '• ��,4`' "u' rte y e.•= ,ri7tZ.7�e _.; g �P Y Y
�,�T E>w't- �:� -... <..•..,,,;,tE;,,�.,,, .,, - , ", ❑Addition of new motor load of ❑' <• ' 2 "1.3
Job no.: SRO Job site address: 10496 SW BONANZA WAY 10011P or more. occupancy.
13 Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: PORTLAND, OR 97224 ❑ Health -care facilities. ❑ Supply voltage for more than
['Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: I Project name: KEN DIXON ❑ Service or feeder 600 amps or more
Cross street/directions to job site: r£u K ms` �1 "
Description OCT. Fee. Total •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Tax map /parcel no
Ea. add'I 500 sq. ft. or portion 33.40 I
-e t ` c a e $ -e Y Limited energy, residential
_ " e'! ' g a R , ,CI Wtr 75.00 2
tEe.r .5�t.t_ :'>a.•: 4 .iZ .�. - -glif :> 41.- 1' , Ors l4 � 4 4 4: ; t' ' i 'li • ^, 71: (with abov sq. ft.)
Limited energy, multi - family
ADD /ALTER CIRCUITS FOR KITCHEN REMODEL residential (with above sq. ft.) 75.00 2
' Services or feeders installation, alteration, and/or relocation
ft4 ttr 1 g 200 amps or less 80.30 2
t ., .u•'f. .- --4 4.17;a - . l ErtiPPAt, r. ,,,;�' 'r tae- ^I Ik., :.� a i t , ,_ t , : 201 amps to 400 amps 106.85 2
Name: KEN DIXON _ 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: 10496 SW BONANZA WAY Over 1,000 amps or volts 454.65 2
City/State /ZIP: PORTLAND, OR 97224 Temporary services or feeders installation, alteration, and /or
relocation
Phone: (503)684 -3629 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
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
*7,,e A. Fee for branch circuits with
a '°' j a : �' � li t , . mot `-r ' --- '4 � above service or feeder fee. 6.65 2
.�>__,_......,teaa� 4Kesvw. „�i_` <, .. .� .s�s if-- , ..z • each branch circuit
Business name: Prairie Electric, Inc. B. Fee for branch circuits
without service or feeder fee, 1 46.85 46.85 2
Contact name: ANITA PASO first branch circuit
Address: 6000 NE 88 STREET Each add'I branch circuit 5 I 6.65 I 33.25 2
Miscellaneous (service or feeder not included)
City/State /ZIP: VANCOUVER, WA 98665 Each manufactured or modular 90.90 2
dwelling, service and /or feeder
Phone: (800) 573 -2750 1 Fax: : (360) 573 -9866 Reconnect only 66.85 2
E -mail: anitap @prairielectric.com Pump or irrigation circle 53.40 2
. .1g,$t : gl r tsi )5P sr{ ;; . :ak,`l. `.^ . i:; a - : v . ' . ; e F d.:'' Sign or outline lighting 53.40 2
Business name: Prairie Electric, Inc. Signal circuit(s) or limited -
energy panel, alteration, or
Address: 6000 NE 88 STREET extension. Describe: Page 2 2
City /State /ZIP: VANCOUVER, WA 98665 Each additional inspection over allowable in an of the above
Per inspection 62.50
Phone: (800) 573 -2750 I Fax: (360) 573 -9866 Investigation per hour (1 hr min) 62.50
CCB Lic.: 60178 Electrical Li C ''--- St(prv. Lic.: 3562S Industrial plant per hour 73.75
� o�'g_ Tr M ;. ryasz'Z: `I z-
Suprv. Electrician signature, required: �`
Or
Subtotal: 80.10
Print name: BILL HALBERG 8- 15-08 Plain review (25% of permit fee):
State surcharge (12% of permit fee): 9.61
Authorized signature: TOTAL PERMIT FEE: 89.71�tr��
Print name: Date: This p ermit application expires if a permit is not obtaine. inpJ80
�, 1, ' i "� il C Ii,. ' " r t' c' tlo n , P � �e -. Pied as comp VVVVVV
"• days after it has been accepted
P!r ermn A ' tir, A A, , � Numbe f . e rmit. 4.3
CITY OF TIGARD
BUILDING DIVISION PERMIT #: EG.C2008- 00306
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 717/2008
Phone: (503) 639 -4171 id 1 f'
. Inspection Requests (24 Hrs.): (503) 639 -4175 ` -..
INSPECTION WORKSHEET FOR DATE: 9/2/2008 TIME: 7:01AM PAGE: 25
SITE ADDRESS: 10496 SW BONANZA WAY CLASS OF WORK:
SUBDIVISION: RIVERVIEW ESTATES NO. 2 LOT #: 082 TYPE OF USE:
PROJECT NAME: DIXON
DESCRIPTION: Installing (7) branch circuits for kitchen remodel.
OWNER: DIXON, KENNETH & KIMBERLEE PHONE #: 603
CONTRACTOR: PRAIRIE ELECTRIC INC PHONE #: 800 -573- 2150
Inspection Request Scheduled For: Date: 9/2/2008 Pour Time:
Code # Inspection Description Co s] 'rm # Contact # Message
120 Electrical rough -iri 07489( 1 503 -624 -5609 N
Corrections /Comments /Instructions:
R2-6.`p1 r � 1' &KALI., COlske LA> IT i
of(N) iVtIP 21O <G V p&N. c...6\ r i
M. 'ASS ❑ PARTIAL APPROVAL ❑ CANCEL Ii NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
AA`` 1.1441/4 1
Inspector: G Iv - 6G Date: 9 1 - 110 Phone #: (503) 718-
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CITY OF TIGARD
BUILDING DIVISION '` PERMIT #: EL.C2008 00386
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/7 /2008
Phone: (503) 639 -4171 ifre t ii „i 1 i
Inspection Requests (24 Hrs.): (503) 639 -4175 A _I I
INSPECTION WORKSHEET FOR DATE: 8128/2008 TIME: 7:OOAM PAGE: • 21
SITE ADDRESS: 10 SW BONANZA WAY CLASS OF WORK:
SUBDIVISION: RIVERVIEW ESTATES N0. 2 LOT #: 082 TYPE OF USE:
PROJECT NAME: DIXON
DESCRIPTION: Installing (7) branch circuits for kitchen remodel.
OWNER: DIXON, KENNETH & KIMC3ERLEE PHONE #: 503- 624 -5609
CONTRACTOR: PRAIRIE ELECTRIC INC PHONE #: 800-573- 2750
Inspection Request Scheduled For: Date: 8/28/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
120 Electrical rough -in 074793 -01 360-573- 2760 N
Corrections /Comments /Instructions:
1 r ' ine '� me A, r II I� /1.1 0 ''' ,t ,
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C �' C���i ! -tip G� / l�� a? 54(i-q/e--- C,� ! 5 Z / `'(
0 • ' I ; 1 4 6441.1 rts // 117r / /,/ /
/ / +
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
K FAIL u)' L L FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: PI) Date: Phone #: (503) 718- 2.0/C)