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Permit
CITY OF TIGARD ELECTRICAL PERMIT jog PERMIT #: ELC2009 -00015 COMMUNITY DEVELOPMENT DATE ISSUED: 1/12/2009 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 2S 102 B C -00110 SITE ADDRESS: 12505 SW BROOKSIDE AVE ZONING: R -4.5 SUBDIVISION: WALNUT ACRES LOT : 009 JURISDICTION: TIG PROJECT: PROWSE Project Description: (5) branch circuits. Kitchen and bathroom rewire. 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: 4 IN PLANT: 601 - 1000 amp: PLAN REVIEW SECTION 1000+ amplvolt: > =4 RES UNITS: > 600 VOLT NOMINAL: Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC: Owner: Contractor: JIN PROWSE 12505 SW BROOKSIDE AVE TIGARD, OR 97223 Phone: 503 -998 -1586 Contact #: FEES Description Date Amount Reg #: [ELPRMT] ELC Permit 1/12/2009 $73.45 [TAX] 12% State Surchar 1/12/2009 $8.81 Total $82.26 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: / N.._41±1 . a , ■ 0 I • 1 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: 1 /0---/ 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. RECEIVED Electrical Permit Application FOR OFFICE USE ONLY - JAN 1 2 2009 Received I / � � t � III City of Tigard Date/By: l I [� c55._ Permit No.: C CCZ ) O O�J h J 13125 SW Hall Blvd., Tigard, OR 9 Plan Review Phone: 503.639.4171 Fax: 503.59 OFTIGARD DateBy: Other Permit: TIGARD Inspection Line: 503.639.4175 BUILDING DIVISION Date Ready /By Juris 0 See Page 2 for Internet: www.tigard - or.gov Notified/Method: T CI Supplemental Information . z:�<< ,, ... " >�. �.. , ::. � » PLANA R :,•� ,TYP,E OF WORK r ❑ 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. El Demolition El Other: where the available fault current ❑ Marinas and boatyards. a k ,,��," exceeds 10,000 amps at 150 volts or Floating buildings. �; -; == ;CATEGORY C = >' 6 < - - > ;Z, ,r' =,:: ;. &,., � .:;,° ;..-- ' x �, <.. 0 Commercial-use It ...- ' Dos,.;, ° : >:�.. <:. ,,< -,.,.:,,.. . -. - �. ; >,;,°,�,,�« ., .,,;,,,�• _ ��;,: -:`� . „ :. ,,;.:< �. <z.:�., ' .�: less to ground, or exceeds 14 0 C ommercta -use gr u ura l ,: 14,000 ❑ agricultural RI1- 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. R ;; , s '. S INORMATION :.AND LOGATTION ;z:'.�%,;•, �- ,,. , .,,;.,:..F.. .. , . :,, ❑ Addition of new motor load of ❑ "A" "E" "1 -2" "1 -3 / ^ I OOHP or more occupancy. Job no.: Job site address: f 2 rof Sw b t PO k S [d G A ✓c ❑ Six or more residential units. ❑ Recreational vehicle parks. City/State/ZIP: , El Health-care facilities. El Supply voltage for more than T 1 S6./ 0 l / / 7 2 &3 ❑ Hazardous locations. 600 volts nominal. Suite /bldg. /apt. no.: / Project name: ❑ Service or feeder 600 amps or more. . ' ; : >,_ 0 SCHED E3. , ..s _, ": mp ; ; 1 Cross street/directions to job site: Description I Qty. I Fee. I Total I New residential single- or multi - family dwelling unit. W k I /auk Arvo k. S /rte- X s- ,-<-ef' Includes attached garage. Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4 Ea. add'l 500 sq. ft. or portion 33.40 1 Tax map /parcel no.: residential <;., , .__. _,�, »y,.,,., �;.. Limited e 75.00 2 Li en erg, rest , ?, iii, 'DESCRIPTION':- na°:, :11 (with » -� ° ' - OF = =` "WORK.,: '. � above sq. ft.) ff- Limited energy, multi 75.00 2 1C; 1' ten/ rt. Wire_ residential (with above sq. ft.) ,�/(,� Services or feeders installation, alteration, and /or relocation b 4.rh r vv.A. fewIf'e 200 amps or less 80.30 2 ,.. " .,,.eye .ss o�:; "i` } ' %a�,tC`i''° '$ PROPERTY; ==OWNER£:_a � ❑ °eTENANT ; .� 201 amps to 400 amps 106.85 2 Name: J: proWs, 401 amps to 600 amps 160.60 2 601 amps to 1,000 amps 240.60 2 Address: /V T SW / J- o ,V. Over 1,000 amps or volts 454.65 2 City /State /ZIP: 1"' N d Q (Z of 7 z Li rj Temporary services or feeders installation, alteration, and /or z / 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 Owner signature: Date: Branch circuits — new, alteration, or extension, per panel A. Fee for branch circuits with ' " `% "' ` 1, , ;''S ®' APPLIGANTrz:" 6 ,, ;,;; CONTACT PER „s„ ° : :.,: , -:.,. <_..._ ....,,,_�� .'ii'- ',r°:.�.. »_.... < ,.. _ � . ...,,,r r «,. °,�.sa, °','S>.';'.. °- 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 9 6.65 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 X1;;,;: :r. 1 ,;: -" < :,,t,, ,� , , Sign or outline lighting ,z, 4 ° ,» <CON1'RAC'TQI2; ,,,, �;, »�• ; ;�- g g g 53.40 2 Signal circuit(s) or limited - Business name: energy panel, alteration or Address: extension. Describe: Page 2 2 W \N City/State /ZIP: v 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 Lie.: Electrical Lie.: Suprv. Lie.: Industrial plant per hour 73.75 `-'';,_ := - ELECTRICAL . CCOT%FEES< _-.' J, ,4 Suprv. Electrician signature, required: Subtotal: - 7 3. t4 S Print name: Date: Plan review (25% of permit fee): State surcharge (12% of permit fee): o . I O• Authorized signature: TOTAL PERMIT FEE: This permit application expires if a permit is not obtained within 180 Print name: Date: 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(1 I /05 /COM/WEB Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: RESIDENTIALW®RK'ONLY: " ;: Fee for all residential systems combined $75.00 Check Type of Work Involved: n Audio and Stereo Systems* n Burglar Alarm n Garage Door Opener* n Heating, Ventilation and Air Conditioning System* ❑ Vacuum Systems* ❑ Other: COM-M *WONRK .ONI Y: Fee for each commercial $75.00 system (SEE OAR 918- 309 -0000) Check Type of Work Involved: ❑ Audio and Stereo Systems • ❑ Boiler Controls n Clock Systems n Data Telecommunication Installation ❑ Fire Alarm Installation n HVAC n Instrumentation n Intercom and Paging Systems ❑ Landscape Irrigation Control* n Medical • n Nurse Calls n Outdoor Landscape Lighting* n Protective Signaling n 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 R t Property Owner Statement Regarding Construction Responsibilities 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 701055 (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: .X I own, reside in, or will reside in the completed structure and my general contractor is: 1`1 t ke PC (5 LA ) Name CCB# Expiration Date I will inform my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. or I will be performing work on property I own, a residence that I reside in, or a residence that I will reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. If I change my mind and hire a general contractor, I will select a contractor who is licensed with the CCB and will immediately give the name of the contractor to the office issuing this Building Permit. I have read and understand the Information Notice to Homeowners About Construction Responsibilities, and I hereby certify that the information on this homeowner statement is true and accurate. 1' k_ e_ ?r6 Print Name of Permit Applicant 2 Si natur6f Permit Applicant Date 9 Permit #: Address: M*72 • Issued by: Date: This Copy for Permit Offices CITY OF TIGARD BUILDING DIVISION PERMIT #: EL.C2 •000k� 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: Phone: (503) 639-4171 Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: L{f 1(r(o TIME: PAGE: SITE ADDRESS: 12 5-0E4 4 5 W a (;),_13t9 l.. S Ltd CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: DESCRIPTION: E1G1 OWNER: PHONE #: CONTRACTOR: ow N PHONE #: Inspection Request Scheduled For: Date: 2 ! 101 Oq Pour Time: Code # Inspection Description Confirm # Contact # Message Corrections /Comments/ Instructions: �kov i( G-f-c-4 P(2-61)01§) JN tZ 1,4 R, . Z P RJ:A' �� 1 k ? \ ~ t_ %wet+ 1 • • . • si)stZaw't E w \\ R.E.vE TEis IN) Olt ); • ) n PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS `A FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: I V te) Date: AI 1 I Phone #: (503) 718- 1146 ' ` , - , • , . _ ., ..., . . _ 'E/...p' :' • -:1 '.., - . : . ' , ' - . • - -- ' ' '-: " - '.-- ik.,,pidd , ._._. .,... _ http:Livokw.tigardmaps.corn/mox52_multimaplindex.cfm?fuseaction=property.summari&CFID=681308i(0 i 4 '4 t X : --. -, - .:1 , '! P- ,..._...... .., --- --- ....... --- . _ - ----- ---- - File Edit View Favorites Tools Help n c i ' ' ' 11 1881'1A Accela Automation®. ,'.:..- City of Tigard, Oregon . 1 1 GI ' ID *. - L... Page ■ ',..r.:i: Tools ■ - - — 12505 SW BROOKSIDE AVE -- Properbp.Suinmary - -• -- -,'- , -- _- -- - _ ___: • I ',\, \-■,,,,,,..,., 1 -- . . I * , Clydes dale . ' W00118,11 Park i ii;,-; „ , . . 1 . 1 I (—) *6) JOHNSON ST ,.' • I ... • 0,. . Z 2; - ' 1149 , _ .. . 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'1/4 --, _ • , : AI C., „ .• -.... 4 ----, Property Owner Info Tax ID Number: 2S102:=Crr' Tax Acccunt Number: R..I63359 Site A.ddress: 12505 SW E.ROCKSIDE AVE Site City: Site ZIP: 97223 C..Nner Address: WI Done ' e Internet *4. 100% - A-.- ..- . . 4 .:....; . i - -...d Inbox - Microsoft ... 1 5 Inspection List CITY OF TIGARD BUILDING DIVISION ` ^ PERMIT #: ELC2009.00015 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/1712009 Phone: (503) 639 -4171 Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: /3012009 TIME: 1 :Q6AM PAGE: 4 SITE ADDRESS: 12505 SW f3ROOKSIDE AVE CLASS OF WORK: SUBDIVISION: WALNUT ACRES LOT #: 009 TYPE OF USE: PROJECT NAME: DROWSE DESCRIPTION: (5) branch circuits. Kitchen and bathroom rewire. OWNER: DROWSE, JIN PHONE #: 503- 991i-150G CONTRACTOR: PHONE #: Inspection Request Scheduled For: Date: 1!30/2009 Pour Time: Code # Inspection Description Confirm_. Contact # Message 120 Electrical rough -in -.000157 -01 e3-990-3529 1 h r Y Corrections /Comments/ Instructions: d R� - sl.� Crrto v Nn t1DO bR5 0 1 rt% p. J ' P-Etkr6iT 6 T' 4 J 4• A ‘---- .X 1 4^A G ---- b(L711kUL., I ❑ PASS jjI' PARTIAL APPROVAL ❑ CANCEL n NO ACCESS 1XCALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: Cr. NL( Date: 1 Ian 09 Phone #: (503) 718 - City of Tigard, Oregon Page 1 of 2 111111 City of Tigard, Oregon " --- O. /iJ.'� \161 /.i1 /N:rd• lr.' (1/ 7'. -. :i < .. Jl ._ 1�J , r . � • f r ,, � TIGARD ' A flare la Call Home � _ 1 Search 1 Property 1 Planning 1 Crimes 1 Transportation 1 Uti 1 Aerial; 1 EOC 1 Street View 1 Print 1 1 Summary 1 Permit Summary 1 Community 1 Hazards I Explorer 1 12505 SW BROOKSIDE AVE Property Summary C o1os date Woo dent Pa,* �n ‘4\ • oo C:-,, u i i 1 4 �' 2 S i a w JOHNSON ST �p o,� "by w r a s). ' • (s�rw `YA (hGr`fl P``�`` il Q ruts Es Cates 44). 4' NO � q< It a � � ,y 1P .. Si. �P� V� \ C`,, r> Property Owner Info Tax ID Number: 251026C00110 Tax Account Number: R463359 Site Address: 12505 SW BROOKSIDE AVE Site City: Site ZIP: 97223 Owner: PROWSE, JIN Y Owner 2: 14982 SW LOOKOUT DR Owner 3: Owner Address: Owner City: TIGARD Owner State: OR Owner ZIP: 97224 Acres: 0.25 Sq Ft: 10,890.0 Bldg SF: 1,114.00 Bldg Value: $ 87,440 Land Value: $ 170,000 Total Value: $ 257,440 Taxable Ass'd Value: $ 131,790 Sale Price: $ 200,000 Sale Date: 12/12/08 Year Built: 1967 District & Community Info Municipality: Tigard Tigard Urban Sery Bndry: YES Tigard Neighborhoods: L Name Link to Website Area 3 Area 3 Neighborhood News School Attendance Areas: http: / /tiggisiw /mox52_multimap/ index. cfm? fuseaction = property. summary &CFID= 100746 &CFTOKEN =... 1/30/2009 CITY OF TIGARD .: . • , BUILDING DIVISION PERMIT #: ELC7009 00015 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: .1/12/2009 Phone: (503) 639 -4171 �I�I Inspection Requests (24 Hrs.): (503) 639 -4175 . '_� "- INSPECTION WORKSHEET FOR DATE: 1/262009 TIME: 7 :O0AM PAGE: 13 SITE ADDRESS: 12506 SW BROOKSIDE AVE CLASS OF WORK: SUBDIVISION: WALNUT ACRES LOT #: 009 TYPE OF USE: PROJECT NAME: PRO %ASE DESCRIPTION: (f) branch circuits. Kitchen and bathroom rewire. OWNER: PROWSE, ,11N PHONE #: 503- 908.1506 CONTRACTOR: PHONE #: Inspection Request Scheduled For: Date: 1/26/2009 Pour Time: Code # Inspection Description Confirm # Contact # Message 120 Electrical rough -in 000005 -02 503 -998 -1586 N Corrections /Comments/ Instructions: 0 C__` 4-12_,L,d...--- 4 Ae c_.4 ,,,,,p & lAi9 u h.ct, L..) .,Aetf Ho - 3 60 /0.0 e S ( ©r- coe6 /ef cep z NEC. 33 V. - 3 O pA. , &3 , U � i-Gc /BeC - -Ca 6e ❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL n NO ACCESS •FAIL ALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: _ �. _% Date: 1 )- 6 0 7 Phone #: (503) 718- �. ;