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Permit CITY TIGARD ELECTRICAL PERMIT CITY #: ELC2002 -00530 P l DEVELOPMENT SERVICES DATE ISSUED: 10/10/02 -`�' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S112BD -00100 SITE ADDRESS: 14620 SW 76TH AVE 057 ZONING: R -12 SUBDIVISION: BLOCK: LOT : 065 JURISDICTION: TIG Project Description: Install 5 branch circuits (fire restoration). 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+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL: Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC: Owner: Contractor: BOROS, STEFAN A + FIVIA KELSO ELECTRIC INC PO BOX 1890 545 SE 3RD GRESHAM, OR 97030 HILLSBORO, OR 97123 Phone: Phone: 503 - 648 -6360 Reg #: ELE 34 -433c SOP 5 FEES Description Date Amount Required Inspections [ELPRMT] ELC Permit 10/10/02 $73.45 [TAX] 8% State Tax 10/10/02 $5.88 Rough - Elect'I Final Total $79.33 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: �� � ��G ,, Permit Signature: � p caLIig I 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: 6 � DATE: LICENSE NO: — - Call 639 -4175 by 7:OOpm for an inspection the next business day FROM : KELSO ELECTRIC INC Oct. " - J T ., 00 00000000 07 2002 12:35PM P4 OCT - 20? lo46 , (6 Cd i I( uy i .kh. .TI ,DING D 1 Electrical Per mit Applicatio - FOR 0FFiCE. !SE ONI 1 ; a ,, Receives i electrical - t , Dare/B : V '/0 —® �'4 s Permit No C /- ©O 5 3 City of Tigard Test Forret B ard/B : Approval S,� it ever: 13125 SW Hall Blvd. Plan RevIcur • ther Tigard, Osegon 9 Aat✓By: PstmttNo,: .Phone: 503. 639 -4171 Fax 503.595 -2960 , . Post- Review Lead seta - Internet; a ww.ci.tigard.or.us !-y : Ji i Datellay; furs J No, U $0.a Page 2 for l' CAMIaCS 24-hear Inspection. Request: 503 - 639 -4175 -R '''''" '" "' Nome./Method: hod: i SttpplcrnentalInfcrmation" _ :..-.-::•. .. ,;t .'ri., •' : T7tn O ;. is :i : ;. ` _i ; : ;< REVIEW ` .la$4c Cbsck: cell ibatip) ; : New construction 1 ❑ Demolition ❑ S over 225 arnps Fi Health - cart facility _` li Adci an/a1teratian/replact+mettt [ Other: Halardot:a coati or. . : „ :.. •� 4, - � . , . 0 cnnttne SCNIGT re rrial tie 371D >rrltps-ratirr6 of ❑ Building over l0,Db0 sou Este, - . .; • :• :''' - , : R. . F'CONS TRIV, -,i° ;Cow; o'3, :; 1 az 2 fOtrtilY tour or enure residential uris in 1 & 2- Family dwelling Commercial/Industrial ❑ System aver GOO malts nominal axle structure Atce soi-y Buildrng I F1�I11f1 -Far i lr ❑ B:uldin over date stares 4 Feedetc. 400 imps cr more I t , Other: ❑ Egress/lighting occupann t load over 99 persons L1 Manufactured muerures or RV park [Maste3' Builder Egress/lighting plan i © Other: IOE'SITRI IrrFO)i MATIO?t°.strid'COr AT(ON ? i. ' • ;3.4. Submit EdIN afptaos with any of the above, t � ' The above arc not a npiicabla to Pantie rev construction service. ob site acidness: 1 - 7, - - 6 � "•”' ` 1zEE° SCBEbtJLL', ::!.i-.::.`.i....: .. ,. , ;;ri l �� �r� • i Suite Y: 1 B 1dg.i p :. -r: . .. _ . , N um b er of or , Unlit ahawed Protect Name: j"fa A ' S Description Qo Pea On.) - Teem ; Foss Sri ee`✓D1ICCtro175 to jab site: New reekicntlakinetc or m�[Iiwnmpy per w dwelling unit Includes *toehold garage_ Service (ached: 1000 sq. ft or less 145.15 4 g 4Qaiti4na1.400 K. tt, or torsion threat 3 -4.9 t Subdivisi 1 Let #:: Limited ere: , rrt cl ial 73,00 z ^ Limited 6.,,cy, non residential 75.00 Tax I ax rnarViparcel #; • £toh maaufuxu. -ed home or mod4Ilt dwelling •..- . • ".1: :. ;0.i. i service aedfor raider 90.90 ` 2 Services or feeders - iastallatloa. t ee' _ >` t)ie�1 74Y) xlWtat103 or relocatioat 200 amps or less 3030 2 • 201 ernes to COO :env . 106.11S 2 401 amps en 00 atop, 160.60 2 :115 PROPERTY''6Vt?#!iF-R'.: • - Eli, ENez`1T „ : • o _401 amps to I COO arois Over 1000 amps or volts - 434.63 2 rsl Nae: _ A`�.. w ,..A - ,7'7 Reco :nectptiy 66.115 a Address: _ Temporary services or fanciers • Instillation, City/State/Zip: aRcrnriert. or rtlocurlopi 200 unps or loss 06 I Phone: Fax: 201 amps to400Amps 100.50 2 -I r4PELIC:Wir. :rn s:i:V., :: : t. ® C0111.+T O.TiRERS I?V ll ;ail , :. :: , dOl to 600 a ' 7s 133, 5 2 Branch austral, - new, adterntioa, or Name: eettasioa per rand: Address: 1. Fee fa: yt8,ch shapers wish purchase of C1TV!St2fC /�lp: 7crice or feeder fccneh larch Sirauit . - 6.65 2 S. Fete for brunch circuits withevt purchase of Phone: : service or feederttts, first branch circuit 1 46.45 y(0 - &) 3 Pack aditrlau1 !mulch circuit ' 6,65 _ . do E-mail: Mise.(Service feeder not included): • " . .... ":' ;CONTRACTOR'• : :i : : -.:':; :: :• . • ptmp_orMrs:Soncircle 53.40 2 Each siv . er 53.40 2 �\ Joe 4: true drenii(c] or slimiest/ c tecgy paaal, e- �f )C alteration. or extension. X5,00 2 Business Namc: - I Address: ,5s' iS , ' `� � ° _ I 1 1 City /State/Zip: / /; i /sir Q 3.71,33 Each additional inspection over the aliowabte In sty of tilt n.b e or c: p / ID 1 , : Per 1 .. .. • hour • min- l hour 62.50 on Phe: �a ,1 f Fax: (,01-a- " VI/ !.'rvtstieation G: - CCB Lic. r: I has-1 i Lic. # :.;-- - j--45T ° . , Supervising electrician/ 'Iii 1: ; ; :: `? • ; .. :radial :Pcrncit' 1res = signature re sired: • tl — — --��� Subtotal i $ �� g - Plan Review (25% of Petitsee); S Print 1\ C: /C I iC. 4 -1. - 7-c. S tate Surdzarge (W of Permit Pee) g 1 TOTAL PERMIT FEE s A.til?10ti23d Notice: This permit app1kittion =Fares 1E a permit is not obtained wit in Signature: Date: 110 days after it has beta accepted as eomplsee. *Fee Med :aerology set by Tel - County Building industry Service Board. (P14 e print nurse) T nnEa, ,,...,. -. - - - - - - - -