Permit .....CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2002 -00532
i � � 'I� L . LOPMENT SERVICES - DA TE ISSUED: 10/10/02
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 PARCEL: 2S112BD -00100
SITE ADDRESS: 14620 SW 76TH AVE 050
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
FEES
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 10/10/02 $73.45
[TAX] 8% State Tax 10/10/02 $5 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 - -3 2 -2344.
Issued By: 0_41.d,yiL, KJ(,r ) Permit Signature: ', _1Q �,c„`jV'
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: d')/\ C4.0 • DATE:
LICENSE NO: 2 'r - 7O S
Call 639 -4175 by 7:OOpm for an inspection the next business day
FROM KEL50 : ELEGTR I C I NC 1 EFC,4 I IL_})
Oct. 177 2002 12 : 34PM P2
OCT ° 7 2002
;lti x of iKKM.
IrDINGDW_ O
Electrical Permit Application r c> GrriCa. >L"SE vvI;1
Received to / tt? p.„... Ca -ups- -D0
e t - - Parmitxo 1
City of Tigard Test Farm Dste/B s Approval P ly it No.:
13125 SW Hall Blvd, Plan Revicw Other
Tigard, Oregon 97223 )oterBy: .. Permit No.: - I
Phone: 503-639-4171 Fax ,i,,,„. 503 - 598.1960 i
Internet: wwvr.ci tig8rt1.C1C,I15 a„ p,- 2'. t DetelBy. Case No,:
�� Fast - Review land Una y
Contact I June -: I ❑ Sae Page 2 for
24 -hour Inspection Request: 503 -639 -4175 - lvameiMett,od: J , Supplemental Infuriantien.
-
4 ;i" E: "0F:'W. :;� _+: ")1 ::.t ,,.i..: -'y : �'1= : i ',i rS ":;!'_:(P.CALNL.lzt +iVIEW.!Z _.li4AQ1Q r _ rCI1N y" :c
.,:..;;:•.':•..... :�;;`L'�t' 03�K�' -.;t ;:` ltfck�It2C '.
k plv .. 1... "': ' r; -,
[l New construction i De..... ❑ Scrv:aovc 225 amps- 0 Hoalth -Taro fkeii'
cotntmrra?_1 0 Litcsrdous loatior.
❑ Addition/alteration/replacement Other: ❑ Scrvicc ova• 320 amps - rasing of 0 Buitding;vet 10,000 iquart: tact
x"•a-' 0 QRV: "i re,,dVS “i Y ON':' ^; t;i'::n i; • 1 & 2 Madly dwellings fovror more reside2l(xl ut::s in
17 2- Faazily m
dwelling 0 Comercial/ dustrial 0 System over 600 alts nominal one slrlentre
01 Accessory cessUIY Bulltim Multi- Family Building over three stories Sonde. 4100 amps .
0 Occupont :cod Over 99 persona Do ma
Martutectired structures or r k RV pa-
" Master Builder LI Other _ ❑ Egresanigbting p:an ❑ Othor:
JO$ •STI$IItiFOIe:ZOL4'.2bd'LDGATION ;:.::. ,'.,,;,
Submit tote ofplaes with any of tho above.
Job site address: I4(o SW - 7(v Tneabovearei rota -p -- to 4. p r,r constr octton crv ^ �
Suite : 1 B1dg. /Aptt.ht: , Number of inspectlonS ,cr permit Allowed
Project Name,: Description - , Or/ J P«(oa) rout
Cross s�eet/D reetions to job site:
New rtiidconotainglc or multi- family pot I I •
J dwelling unit - Includes attached tangs.
Servicetectoded:
1000 sq. it or Iris 1 145.15 4
: `.•a: to 50-.. or•.0c +r +.t `-. .'t
Limited e y , residential residential • 75.60 -
SUbdI I.SIOIt: I Lot #: .. Li erletrv, rx)e ocOaratisl 75.00 1 2
T 3X ta9.>1/ el #: Etch manufactured home or modular deeding I 1
• .- - service ondrfr feeder 1 9C.90 1 1
.. _:.. " � � �._' = '.:'D�S£�f.P, oF.. _:'z1 ::' ;'a :�:; �,•. � �:; ": _ � ��•:� �
Services or feeders - rut sLon,
F ir - R vise theratiotr or t tk■tt:
200 amps or less - . - 30.30 ' 2 1
r — 201 amps to 400 st�4 :OGYS 2
401 amps tD 600 unp� 160,60 2
&S zoPEit3'4^ itrER:: rr' i® +28 �'£.`_;':::_ . -. it . • .1 a 1000. .. 4d -6 2 • Orcr 1000 mtrpseevolts 45 El
CO Nante: a 4.4- • ,► • Rscon - • 1 - am 66.85 2
Add : • Temporary services or feeders • 41st:ilutlon,
atteration, or relocation:
City(Stata/Zip : 200 am or Ices 66.85 I
Phone: Pax: '
ktP,CA -� _ . aita� io , o } 1 5,95
Z01 stnpetod00am III 10(130 2
hol SOD in p= 3 2
aLI-N
,r - _-;r::,. " -�)'s.::,t.Q" cr Branch Cit'CVit9 - ntw, t a Y
.0
Name: extension per panel:
._ Pee fo: banal ,rh circuit, will purchase Of
I Address: twice or feeder f^-r, ch branch circuit 6.6 2 j
i Citv'State /Zip: B- Foe for branch cireohi witll0ui purchase of
2
Phone: Each ediitienai branch ci brinGh circuit 1 6.63 D(Q. (PO ?
Fax:
B -bail: Mire.(Sorviceorfocda not included):
. _- •- c . - - . .': CON'1'RA'C 'OR'i - -. .... . . . .. ... . EL''' pir:a or Ir'122•KOn circle s?.53.4C) 2
. .,-.. . - , . . . . . Each a or outline li _a`nk 53.40 _ - 2
Job No Signal circuit(a) or a litnitad energy panes,
BuFiness Name: rE4 F J - 4 rl Trt - ..-.. entian• 75,00 2
Address: - X1
i Each additional int ection over the allowable in any of the above:
City+State/Zip: Hl ity , cK • cil1<d3 _ - Per i :.. •- hoer - min. l hour 1 62.'0
} Phone: 101:1- 8 co3 (a Fax: ( � ?' /`mod i / invest f=: l '
r6/ 1 Liz.. #: - ` g� Other.
CCB Lit. Y: ,�, Ii... ;a;:= - .. - :` ec'aii:i14ei ieit . :7 -: 1 ': i.; , :.7• :;..; ••:•::":: .
Supervising electrician V / Subtotal i S 11M
signature requited: - • Pleb Review (25% of Permit Fee) 1 s e.
r t " Litt, � Stntc Sul- char3.0Y° of P Fee) S
Print Name: �a " 1;,,, TOTAL FERKIT FE/ s 1
Aulttorr2ed i\totior This permit application expires if t permit is Oat obi:need m'l1i
Signanlre: Date: Ign days situ IL has bona accepted lie ample!*.
•Fee methodology set by T'ri- (.aunty Building Industry Service Board.
(Flees; print name)
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